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Previous Volume 350:1287-1295 March 25, 2004 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Lister, T. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The efficacy of first-line intensive chemotherapy plus transplantation of autologous hematopoietic stem cells in adults with disseminated aggressive lymphoma is unknown.

Methods We compared high-dose therapy plus autologous stem-cell support with the standard regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in a randomized trial. The patients were 15 to 60 years of age, had untreated aggressive lymphoma, and were at low, low intermediate, or high intermediate risk of death (i.e., a maximum of two adverse prognostic factors) according to the age-adjusted International Prognostic Index. The primary outcome was event-free survival at five years.

Results Of 207 consecutive patients, 197 underwent randomization; 99 were assigned to receive CHOP, and 98 to receive high-dose chemotherapy plus stem-cell transplantation. Overall, 78 percent of the patients completed the assigned treatment; the median follow-up was four years. The estimated event-free survival rate (±SD) at five years was significantly higher among patients who received high-dose therapy than among patients who received CHOP (55±5 percent vs. 37±5 percent, P=0.037). Among patients with a high intermediate risk of death, according to the age-adjusted International Prognostic Index, the five-year survival rate was significantly higher after high-dose therapy than after CHOP (74±6 percent vs. 44±7 percent, P=0.001).

Conclusions High-dose chemotherapy with autologous stem-cell support is superior to CHOP in adults with disseminated aggressive lymphoma.

Source Information

From University Hospital of Nantes, Nantes (N.M., F.G., J.-L.H.); Jean Minjoz Hospital of Besançon, Besançon (E.D.); Jean Bernard Hospital of Poitiers, Poitiers (V.D.); University Hospital of Angers, Angers (C.F.); University Hospital of Brest, Brest (C.B.); University Hospital of Grenoble, Grenoble (R.G.); Centre Hospitalier Departemental of Orleans, Orleans (V.L.); and University Hospital of Tours, Tours (P.C.) — all in France.

Address reprint requests to Dr. Milpied at the Service d'Hématologie, CHU Nantes, 44035 Nantes CEDEX, France, or at noel.milpied{at}chu-nantes.fr.

Full Text of this Article

Related Letters:

Intensive Therapy for Aggressive Lymphoma
Aguiar Bujanda D., Bohn Sarmiento U., Aguiar Morales J., Bolaños-Meade J., Herishanu Y., Zomas A., Skandalis A., Milpied N.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:98-100, Jul 1, 2004. Correspondence

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