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Lymphomas

Long-term follow-up of advanced-stage low-grade lymphoma patients treated upfront with high-dose sequential chemotherapy and autograft

Leukemia volume 14, pages 740–747 (2000)Cite this article

Abstract

Long-term outcome, after first line intensified high-dose sequential (i-HDS) chemotherapy, was evaluated in 46 patients, aged ⩽65 years, with advanced low-grade lymphoma. Seventeen patients had small lymphocytic lymphoma (SLL), 29 had follicular lymphoma (FL), 10 of them with histologic transformation. I-HDS included: (1) tumor debulkying, by 2 APO+2 DHAP courses; (2) sequential administration of high-dose (hd) etoposide, methotrexate, and cyclophosphamide, followed by peripheral blood progenitor cell (PBPC) harvest; (3) hd-mitoxantrone + melphalan with PBPC autograft. Ten FL patients had their PBPC immunologically purged ex vivo. There were two treatment-related deaths; five FL patients had short-lasting response followed by disease progression, five SLL reached a stable PR; overall, 34 patients (74%) reached CR. At a median follow-up of 4.3 years, the estimated 9-year OS and EFS were 84% and 45%, respectively. No significant differences were observed in the OS among patients at low, intermediate or high IPI score, with an estimated OS projection of 95%, 78%, and 75%, respectively. FL had longer survival without evidence of residual disease (9-year EFS: 59%) as compared to SLL patients (8.8-year EFS: 17%); however, both groups had prolonged survival and no need of salvage treatment, as shown by the time to disease progression curve, projected to 66% and 62% for SLL and FL, respectively. The results indicate that hd-approach in low-grade lymphoma: (1) is associated with longer progression-free survival as compared to conventional therapies; (2) may imply higher tumor mass reduction in FL as compared to SLL patients; (3) offers long life expectancy, with potential survival benefits at least for patients at intermediate/high IPI score.

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Acknowledgements

We thank the whole staff of the Divisione Universitaria di Ematologia and Centro Dipartimentale Trapianto Midollo, S Giovanni Hospital, Torino for help and patient care. This work was supported in part by Consiglio Nazionale delle Ricerche, Rome, Italy (special project ACRO, grant No. 96.00742.PF39 to TC and No. 96.00615.PF39 to AP), and by Associazione Italiana Ricerca sul Cancro, Milan, Italy

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  1. Dipartimento di Medicina e Oncologia Sperimentale, Div Universitaria di Ematologia, Italy

    C Tarella, D Caracciolo, P Corradini, F Zallio, M Ladetto, A Cuttica, P Gavarotti & A Pileri

  2. Ist di Radioterapia, Servizio II, Azienda Ospedaliera S Giovanni Battista di Torino, Italy

    G Rossi

  3. Ist Anatomia Patologica, Servizio II, Azienda Ospedaliera S Giovanni Battista di Torino, Italy

    D Novero

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Tarella, C., Caracciolo, D., Corradini, P. et al. Long-term follow-up of advanced-stage low-grade lymphoma patients treated upfront with high-dose sequential chemotherapy and autograft. Leukemia 14, 740–747 (2000). https://doi.org/10.1038/sj.leu.2401737

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