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Originally published as JCO Early Release 10.1200/JCO.2003.10.023 on September 29 2003

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Journal of Clinical Oncology, Vol 21, Issue 21 (November), 2003: 3918-3927
© 2003 American Society for Clinical Oncology

High-Dose Therapy Improves Progression-Free Survival and Survival in Relapsed Follicular Non-Hodgkin’s Lymphoma: Results From the Randomized European CUP Trial

Harry C. Schouten, Wendi Qian, Stein Kvaloy, Adolfo Porcellini, Hans Hagberg, Hans Erik Johnsen, Jeanette K. Doorduijn, Matthew R. Sydes, Gunnar Kvalheim

From the University Hospital Maastricht, Maastricht, and the Erasmus Medical Center, Rotterdam, the Netherlands; Medical Research Council Clinical Trials Unit, London, United Kingdom; Norwegian Radium Hospital, Oslo, Norway; Ospedale P.F. Calvi, Noale, Italy; University Hospital of Uppsala, Sweden; Herlev University Hospital, Copenhagen, Denmark.

Address reprint requests to Harry C. Schouten, MD, PhD, University Hospital Maastricht, Department of Internal Medicine, Section of Hematology-Oncology, PO Box 5800, 6202 AZ Maastricht, the Netherlands; e-mail: hsch{at}sint.azm.nl.

Purpose: To determine, in a randomized clinical trial, whether high-dose therapy (HDT) followed by autologous stem-cell transplantation is more effective than standard treatment with regard to progression-free survival (PFS) and overall survival (OS) in patients with relapsed follicular non-Hodgkin’s lymphoma; and to assess the additional value of B-cell purging of the stem-cell graft with regards to PFS and OS.

Patients and Methods: Patients received three cycles of chemotherapy. Responding patients with limited bone marrow infiltration were eligible for random assignment to three further cycles of chemotherapy (C), unpurged HDT (U), or purged HDT (P).

Results: Between August 1993 and April 1997, 140 patients were registered from 36 centers internationally, and 89 were randomly assigned. Reasons for not randomizing included patient refusal, early progression, or death on induction therapy. With a 69-month median follow-up, the log-rank P value for PFS and OS were .0037 and .079, respectively. For PFS, the hazard ratios (95% CIs) for U versus C, P versus C, and P versus U were 0.33 (0.16 to 0.70), 0.38 (0.19 to 0.79), and 1.02 (0.51 to 2.05), respectively. The hazard ratio (95% CI) for C versus U + P was 0.30 (0.15 to 0.61). Hazard ratios (95% CIs) for OS were 0.43 (0.18 to 1.06), 0.43 (0.18 to 1.02), and 0.72 (0.32 to 1.63). For C versus U + P, the hazard ratio (95% CI) was 0.40 (0.18 to 0.89). Kaplan-Meier estimates (95% CIs) of 2-year PFS for C, U, and P were 26% (8% to 44%), 58% (37% to 79%), and 55% (34% to 75%), respectively. OS at 4 years for C, U, and P are 46% (25% to 67%), 71% (52% to 91%), and 77% (60% to 95%) respectively.

Conclusion: HDT significantly improves PFS and OS. There is no clear evidence of benefit through purging.

This trial was partially supported by a grant from Baxter GmBH (Unterschleissheim, Germany).


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