The role of intensive therapy and autologous blood and marrow transplantation for chemotherapy-sensitive relapsed and primary refractory non-Hodgkin's lymphoma

Identification of major prognostic groups

H. Miles Prince, Kevin Imrie, Crump Michael, Alexander Keith Stewart, Carounk Girouard, Richard Colwill, Joseph Brandwein, Richard W. Tsang, J. Gerald Scott, David M C Sutton, Dominic Pantalony, Kelvin Carstairs, Simon B. Sutcliffe, Armand Keating

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Patients with intermediate grade non-Hodgkin's lymphoma (NHL) who relapse or fail to achieve a complete remission after anthracycline-containing induction regimens have a poor outcome with conventional-dose salvage treatment. This outcome may be improved with intensive therapy and autologous transplantation (ABMT) but even in patients with proven chemotherapy-sensitive disease, relapse rates of up to 60% are observed. Reliable and powerful prognostic indicators are needed to identify appropriate patients for this expensive procedure and those subjects to whom alternative or additional treatment should be offered. We were interested in testing the hypothesis that tumour burden, and hence remission status immediately prior to transplant, is an important prognostic indicator of survival. We aggressively treated patients with conventional-dose salvage chemotherapy to maximum tumour response, and tested, by multivariate regression analysis, predictors of outcome post-transplant. We studied 81 consecutive patients with intermediate grade and immunoblastic NHL who achieved either a partial (PR) or complete remission (CR) following repetitive cycles of conventional-dose salvage therapy. Intensive therapy consisted of etoposide (60 mg/kg) and intravenous melphalan (160-180 mg/m2) with or without total body irradiation (TBI) followed by infusion of autologous unpurged bone marrow and/or blood cells. The predicted 4-year survival and progression-free survival (PFS) with a median follow-up of 37 months was 58% and 48% (95% confidence interval (CI) 37-55%), respectively. The only factor predictive of outcome was remission status at transplant (P = 0-0001). The PFS at 4 years for the CR group was 61% (95% CI 53-75%). In contrast, only 25% (95% CI 11-40%) of patients undergoing autotransplant in PR were progression free at 4 years. We conclude that remission status at transplant after maximum tumour reduction is a powerful prognostic indicator.

Original languageEnglish (US)
Pages (from-to)880-889
Number of pages10
JournalBritish Journal of Haematology
Volume92
Issue number4
StatePublished - 1996
Externally publishedYes

Fingerprint

Non-Hodgkin's Lymphoma
Transplantation
Bone Marrow
Drug Therapy
Transplants
Salvage Therapy
Confidence Intervals
Disease-Free Survival
Therapeutics
Recurrence
Melphalan
Survival
Autologous Transplantation
Whole-Body Irradiation
Anthracyclines
Autografts
Etoposide
Tumor Burden
Bone Marrow Cells
Blood Cells

Keywords

  • Autotransplant
  • Etoposide
  • Lymphoma
  • Melphalan
  • Prognostic factors

ASJC Scopus subject areas

  • Hematology

Cite this

The role of intensive therapy and autologous blood and marrow transplantation for chemotherapy-sensitive relapsed and primary refractory non-Hodgkin's lymphoma : Identification of major prognostic groups. / Prince, H. Miles; Imrie, Kevin; Michael, Crump; Stewart, Alexander Keith; Girouard, Carounk; Colwill, Richard; Brandwein, Joseph; Tsang, Richard W.; Scott, J. Gerald; Sutton, David M C; Pantalony, Dominic; Carstairs, Kelvin; Sutcliffe, Simon B.; Keating, Armand.

In: British Journal of Haematology, Vol. 92, No. 4, 1996, p. 880-889.

Research output: Contribution to journalArticle

Prince, HM, Imrie, K, Michael, C, Stewart, AK, Girouard, C, Colwill, R, Brandwein, J, Tsang, RW, Scott, JG, Sutton, DMC, Pantalony, D, Carstairs, K, Sutcliffe, SB & Keating, A 1996, 'The role of intensive therapy and autologous blood and marrow transplantation for chemotherapy-sensitive relapsed and primary refractory non-Hodgkin's lymphoma: Identification of major prognostic groups', British Journal of Haematology, vol. 92, no. 4, pp. 880-889.
Prince, H. Miles ; Imrie, Kevin ; Michael, Crump ; Stewart, Alexander Keith ; Girouard, Carounk ; Colwill, Richard ; Brandwein, Joseph ; Tsang, Richard W. ; Scott, J. Gerald ; Sutton, David M C ; Pantalony, Dominic ; Carstairs, Kelvin ; Sutcliffe, Simon B. ; Keating, Armand. / The role of intensive therapy and autologous blood and marrow transplantation for chemotherapy-sensitive relapsed and primary refractory non-Hodgkin's lymphoma : Identification of major prognostic groups. In: British Journal of Haematology. 1996 ; Vol. 92, No. 4. pp. 880-889.
@article{51f90e0a250b49649fa0c01afbda430e,
title = "The role of intensive therapy and autologous blood and marrow transplantation for chemotherapy-sensitive relapsed and primary refractory non-Hodgkin's lymphoma: Identification of major prognostic groups",
abstract = "Patients with intermediate grade non-Hodgkin's lymphoma (NHL) who relapse or fail to achieve a complete remission after anthracycline-containing induction regimens have a poor outcome with conventional-dose salvage treatment. This outcome may be improved with intensive therapy and autologous transplantation (ABMT) but even in patients with proven chemotherapy-sensitive disease, relapse rates of up to 60{\%} are observed. Reliable and powerful prognostic indicators are needed to identify appropriate patients for this expensive procedure and those subjects to whom alternative or additional treatment should be offered. We were interested in testing the hypothesis that tumour burden, and hence remission status immediately prior to transplant, is an important prognostic indicator of survival. We aggressively treated patients with conventional-dose salvage chemotherapy to maximum tumour response, and tested, by multivariate regression analysis, predictors of outcome post-transplant. We studied 81 consecutive patients with intermediate grade and immunoblastic NHL who achieved either a partial (PR) or complete remission (CR) following repetitive cycles of conventional-dose salvage therapy. Intensive therapy consisted of etoposide (60 mg/kg) and intravenous melphalan (160-180 mg/m2) with or without total body irradiation (TBI) followed by infusion of autologous unpurged bone marrow and/or blood cells. The predicted 4-year survival and progression-free survival (PFS) with a median follow-up of 37 months was 58{\%} and 48{\%} (95{\%} confidence interval (CI) 37-55{\%}), respectively. The only factor predictive of outcome was remission status at transplant (P = 0-0001). The PFS at 4 years for the CR group was 61{\%} (95{\%} CI 53-75{\%}). In contrast, only 25{\%} (95{\%} CI 11-40{\%}) of patients undergoing autotransplant in PR were progression free at 4 years. We conclude that remission status at transplant after maximum tumour reduction is a powerful prognostic indicator.",
keywords = "Autotransplant, Etoposide, Lymphoma, Melphalan, Prognostic factors",
author = "Prince, {H. Miles} and Kevin Imrie and Crump Michael and Stewart, {Alexander Keith} and Carounk Girouard and Richard Colwill and Joseph Brandwein and Tsang, {Richard W.} and Scott, {J. Gerald} and Sutton, {David M C} and Dominic Pantalony and Kelvin Carstairs and Sutcliffe, {Simon B.} and Armand Keating",
year = "1996",
language = "English (US)",
volume = "92",
pages = "880--889",
journal = "British Journal of Haematology",
issn = "0007-1048",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - The role of intensive therapy and autologous blood and marrow transplantation for chemotherapy-sensitive relapsed and primary refractory non-Hodgkin's lymphoma

T2 - Identification of major prognostic groups

AU - Prince, H. Miles

AU - Imrie, Kevin

AU - Michael, Crump

AU - Stewart, Alexander Keith

AU - Girouard, Carounk

AU - Colwill, Richard

AU - Brandwein, Joseph

AU - Tsang, Richard W.

AU - Scott, J. Gerald

AU - Sutton, David M C

AU - Pantalony, Dominic

AU - Carstairs, Kelvin

AU - Sutcliffe, Simon B.

AU - Keating, Armand

PY - 1996

Y1 - 1996

N2 - Patients with intermediate grade non-Hodgkin's lymphoma (NHL) who relapse or fail to achieve a complete remission after anthracycline-containing induction regimens have a poor outcome with conventional-dose salvage treatment. This outcome may be improved with intensive therapy and autologous transplantation (ABMT) but even in patients with proven chemotherapy-sensitive disease, relapse rates of up to 60% are observed. Reliable and powerful prognostic indicators are needed to identify appropriate patients for this expensive procedure and those subjects to whom alternative or additional treatment should be offered. We were interested in testing the hypothesis that tumour burden, and hence remission status immediately prior to transplant, is an important prognostic indicator of survival. We aggressively treated patients with conventional-dose salvage chemotherapy to maximum tumour response, and tested, by multivariate regression analysis, predictors of outcome post-transplant. We studied 81 consecutive patients with intermediate grade and immunoblastic NHL who achieved either a partial (PR) or complete remission (CR) following repetitive cycles of conventional-dose salvage therapy. Intensive therapy consisted of etoposide (60 mg/kg) and intravenous melphalan (160-180 mg/m2) with or without total body irradiation (TBI) followed by infusion of autologous unpurged bone marrow and/or blood cells. The predicted 4-year survival and progression-free survival (PFS) with a median follow-up of 37 months was 58% and 48% (95% confidence interval (CI) 37-55%), respectively. The only factor predictive of outcome was remission status at transplant (P = 0-0001). The PFS at 4 years for the CR group was 61% (95% CI 53-75%). In contrast, only 25% (95% CI 11-40%) of patients undergoing autotransplant in PR were progression free at 4 years. We conclude that remission status at transplant after maximum tumour reduction is a powerful prognostic indicator.

AB - Patients with intermediate grade non-Hodgkin's lymphoma (NHL) who relapse or fail to achieve a complete remission after anthracycline-containing induction regimens have a poor outcome with conventional-dose salvage treatment. This outcome may be improved with intensive therapy and autologous transplantation (ABMT) but even in patients with proven chemotherapy-sensitive disease, relapse rates of up to 60% are observed. Reliable and powerful prognostic indicators are needed to identify appropriate patients for this expensive procedure and those subjects to whom alternative or additional treatment should be offered. We were interested in testing the hypothesis that tumour burden, and hence remission status immediately prior to transplant, is an important prognostic indicator of survival. We aggressively treated patients with conventional-dose salvage chemotherapy to maximum tumour response, and tested, by multivariate regression analysis, predictors of outcome post-transplant. We studied 81 consecutive patients with intermediate grade and immunoblastic NHL who achieved either a partial (PR) or complete remission (CR) following repetitive cycles of conventional-dose salvage therapy. Intensive therapy consisted of etoposide (60 mg/kg) and intravenous melphalan (160-180 mg/m2) with or without total body irradiation (TBI) followed by infusion of autologous unpurged bone marrow and/or blood cells. The predicted 4-year survival and progression-free survival (PFS) with a median follow-up of 37 months was 58% and 48% (95% confidence interval (CI) 37-55%), respectively. The only factor predictive of outcome was remission status at transplant (P = 0-0001). The PFS at 4 years for the CR group was 61% (95% CI 53-75%). In contrast, only 25% (95% CI 11-40%) of patients undergoing autotransplant in PR were progression free at 4 years. We conclude that remission status at transplant after maximum tumour reduction is a powerful prognostic indicator.

KW - Autotransplant

KW - Etoposide

KW - Lymphoma

KW - Melphalan

KW - Prognostic factors

UR - http://www.scopus.com/inward/record.url?scp=0029920432&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029920432&partnerID=8YFLogxK

M3 - Article

VL - 92

SP - 880

EP - 889

JO - British Journal of Haematology

JF - British Journal of Haematology

SN - 0007-1048

IS - 4

ER -