Journal of Clinical Oncology, Vol 18, Issue 16
(August), 2000: 3025-3030
© 2000 American Society for Clinical Oncology
Survival Benefit of High-Dose Therapy in Poor-Risk Aggressive Non-Hodgkin’s Lymphoma: Final Analysis of the Prospective LNH87–2 Protocol—A Groupe d’Etude des Lymphomes de l’Adulte Study
By Corinne Haioun,
Eric Lepage,
Christian Gisselbrecht,
Gilles Salles,
Bertrand Coiffier,
Pauline Brice,
André Bosly,
Pierre Morel,
Christiane Nouvel,
Hervé Tilly,
Pierre Lederlin,
Catherine Sebban,
Josette Brière,
Philippe Gaulard,
Félix Reyes
From the Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil; Hôpital Saint-Louis, AP-HP, Paris; Centre Hospitalier Lyon-Sud, Pierre Bénite; Centre Henri Becquerel, Rouen; Centre Hospitalier Huriez, Lille; Hôpital Purpan, Toulouse; Hôpitaux de Brabois, Nancy; Centre Léon Bérard, Lyon, France; and Cliniques Universitaires de Mont Godinne, Yvoir, Belgium.
Address reprint requests to Corinne Haioun, MD, Service d’Hématologie Clinique, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; email corinne .haioun{at}hmn.ap-hop-paris.fr
PURPOSE: To present the final analysis, with a median follow-up of 8 years, of the LNH87–2 randomized study, which compares consolidative sequential chemotherapy (ifosfamide plus etoposide, asparaginase, and cytarabine) with high-dose therapy (HDT) using cyclophosphamide, carmustine, and etoposide (CBV regimen) followed by stem-cell transplantation in patients with aggressive non-Hodgkin’s lymphoma in first complete remission after induction, focusing on high/intermediate- and high-risk patients identified by the age-adjusted international prognostic index.
PATIENTS AND METHODS: Among the 916 eligible patients, 451 presented with two (n = 318) or three (n = 133) risk factors. After reaching complete remission to induction therapy, 236 of these higher risk patients were assessable for the consolidation phase, with 125 patients in the HDT arm and 111 in the sequential chemotherapy arm.
RESULTS: Among these 451 higher risk patients, 277 (61%) achieved complete remission after induction treatment. In the population of 236 randomized patients, HDT was superior to sequential chemotherapy, with 8-year disease-free survival rates of 55% (95% confidence interval [CI], 46% to 64%) and 39% (95% CI, 30% to 48%), respectively (P = .02; relative risk, 1.56). The 8-year survival rate was significantly superior in the HDT arm (64%; 95% CI, 55% to 73%) compared with the sequential chemotherapy arm (49%; 95% CI, 39% to 59%) (P = .04; relative risk, 1.51).
CONCLUSION: On the basis of the final analysis of this prospectively treated series of patients, retrospectively analyzed on the basis of the International Prognostic Index, we hypothesize that HDT benefits patients at higher risk who achieve complete remission after induction treatment.
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