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Volume 332:1045-1051 April 20, 1995 Number 16 Next

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ABSTRACT

Background High-dose chemoradiotherapy combined with autologous bone marrow transplantation can cure patients with disseminated, aggressive non-Hodgkin's lymphoma in whom first-line chemotherapy has failed. In contrast, cure is rare with second-line chemotherapy. It has been suggested that patients with slow responses to the initial phase of first-line chemotherapy are at high risk for relapse. Therefore, such patients are potential candidates for early bone marrow transplantation.

Methods To investigate whether patients with slow responses, defined as only a partial response after three courses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), would benefit from early transplantation, we conducted a prospective, randomized trial. The early application of high-dose chemoradiotherapy and autologous bone marrow transplantation was compared with the continuation of CHOP therapy for another five courses. Patients with complete responses after three courses of CHOP (fast responses) and patients who responded partially but still had tumor-positive marrow continued with another five courses of CHOP. The study end points were the response rate, overall survival, disease-free survival, and event-free survival.

Results Of 286 patients who could be evaluated for the rapidity of their response after three courses of CHOP, 38 percent had fast responses, 47 percent had slow responses, and 15 percent had no response. Among 106 patients with slow responses who had lymphoma-negative marrow, 69 patients (65 percent) were randomized. Seventy-four percent of the CHOP group and 68 percent of the transplantation group had complete remissions (P = 0.54). At four years the rates of overall, disease-free, and event-free survival were 85, 72, and 53 percent, respectively, in the CHOP group and 56, 60, and 41 percent in the transplantation group (P>0.10). The disease-free survival in both groups did not differ significantly from that of nonrandomized patients with fast responses (54 percent at four years).

Conclusions The early application of high-dose, marrow-ablative chemoradiotherapy with autologous bone marrow transplantation does not improve the outcome in patients with aggressive non-Hodgkin's lymphoma that responds slowly to first-line CHOP chemotherapy.

Source Information

From the Department of Hematology, University Hospital, Utrecht (L.F.V., A.W.D., G.C.G.); the Dr. Daniel den Hoed Cancer Center, Rotterdam (W.L.J.P., A.H., B.L.); the Department of Hematology and Oncology, University Hospital, Maastricht (H.C.S.); the Department of Hematology, University Hospital, Rotterdam (P.S., B.L.); the Department of Hematology, University Hospital, Groningen (G.W.I.); the Department of Hematology, University Hospital, Leiden (H.C.K.-N.); the Department of Hematology, University Hospital, Nijmegen (J.M.M.R.); the Department of Hematology, Academic Medical Center, Amsterdam (R.H.J.O.); and the Department of Hematology, Leyenburg Hospital, the Hague (H.L.H.) — all in the Netherlands; and the Department of Oncology and Hematology, Free University, Brussels, Belgium (R.S.).

Address reprint requests to Dr. Verdonck at the University Hospital Utrecht, Department of Hematology (G03.647), P.O. Box 85.500, 3508 GA Utrecht, the Netherlands.

Full Text of this Article

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Bone Marrow Transplantation versus Chemotherapy in Non-Hodgkin's Lymphoma
Seymour J. F., Flecknoe-Brown S., Mross K., Burke H. B., Nimer S. D., Zelenetz A., Portlock C., Finckh W., Fielding A. K., Pearce R. M., Goldstone A. H., Selwyn M. R., Verdonck L. F., van Putten W. L.J., Hagenbeek A., Walker A. M.
Extract | Full Text  
N Engl J Med 1995; 333:727-730, Sep 14, 1995. Correspondence

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