Journal of Clinical Oncology, Vol 11, 1846-1851, Copyright © 1993 by American Society of Clinical Oncology
High-dose chemotherapy and autologous hematopoietic stem-cell transplantation for aggressive non-Hodgkin's lymphoma
JM Vose, JR Anderson, A Kessinger, PJ Bierman, P Coccia, EC Reed, B Gordon and JO Armitage
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3330.
PURPOSE: To evaluate clinical and tumor characteristics in patients
receiving high-dose chemotherapy and autologous peripheral stem-cell
transplantation (PSCT) or bone marrow transplantation (ABMT) for relapsed
or primary refractory non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS:
One hundred fifty-eight patients with NHL received high- dose chemotherapy
and ABMT or PSCT. A multivariate analysis of characteristics was performed
for comparison of the long-term failure- free survival (FFS) rate. RESULTS:
Using a multivariate analysis, a prognostic model was constructed with
patients in the good-prognosis group being those without a mass > or =
10 cm at the time of transplant, and no more than one of the following
characteristics: three or more prior chemotherapy regimens, lactate
dehydrogenase (LDH) level above normal, and chemotherapy resistance.
Patients in the poor- prognosis group had a mass > or = 10 cm, or two of
the other characteristics noted. The poor-prognosis group had a 3-year FFS
rate of 10%, compared with a 45% 3-year FFS in the good-prognosis group (P
< .001). Within the prognostic groups, there was no difference in the 3-
year FFS rate of the poor-prognosis patients who received ABMT versus PSCT
(10% v 12%; not significant). However, in the good-prognosis group,
patients who received ABMT had a 3-year FFS rate of 32%, compared with 70%
for those who received PSCT (P < .008). CONCLUSION: This prognostic
model can identify patients with good and poor prognoses following
high-dose chemotherapy and ABMT or PSCT for aggressive NHL. In
good-prognosis patients, those who received PSCT had a superior FFS rate.
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