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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.
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.
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N Engl J Med 2004;
351:98-100, Jul 1, 2004.
Correspondence
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