PURPOSE: Improved survival has been observed in aggressive non-Hodgkin's lymphoma (NHL) patients with adverse prognostic factors when autotransplantation (ASCT) was performed after complete remission. However, there is no agreement on the prognostic factors for patients treated with ASCT. We aimed to estimate the prognostic effect of clinical and biologic variables on relapse and survival rates by pooling the data from two trials. PATIENTS AND METHODS: Of the patients treated in the LNH87 and LNH93 trials, 330 under age 60 years achieved complete remission after high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone, and received consolidative ASCT; 16% of patients had T-cell NHL. The International Prognostic Index (IPI) score was 0 for 11%, 1 for 23%, 2 for 51%, and 3 for 15%. Univariate and Cox multivariate survival analyses were retrospectively performed on this population. RESULTS: Overall survival was 75 +/- 5% at 5 years and disease-free survival (DFS) 67 +/- 5%. For T-cell NHL, these scores were 54% and 44%, respectively. The IPI score had no prognostic value and only the following parameters adversely affected overall survival and DFS (P <.05): marrow involvement; more than one extranodal site; histology (nonanaplastic T-cell v others); and type of anthracycline (mitoxantrone v doxorubicin, for DFS only). CONCLUSION: These results suggest that ASCT can prevent relapse in patients with adverse IPI factors. However, patients presenting with a nonanaplastic T-cell phenotype, more than one extranodal site, or marrow involvement still have a higher risk of relapse. These factors should be taken into account when designing post-ASCT maintenance studies.
PURPOSE: Improved survival has been observed in aggressive non-Hodgkin's lymphoma (NHL) patients with adverse prognostic factors when autotransplantation (ASCT) was performed after complete remission. However, there is no agreement on the prognostic factors for patients treated with ASCT. We aimed to estimate the prognostic effect of clinical and biologic variables on relapse and survival rates by pooling the data from two trials. PATIENTS AND METHODS: Of the patients treated in the LNH87 and LNH93 trials, 330 under age 60 years achieved complete remission after high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone, and received consolidative ASCT; 16% of patients had T-cell NHL. The International Prognostic Index (IPI) score was 0 for 11%, 1 for 23%, 2 for 51%, and 3 for 15%. Univariate and Cox multivariate survival analyses were retrospectively performed on this population. RESULTS: Overall survival was 75 +/- 5% at 5 years and disease-free survival (DFS) 67 +/- 5%. For T-cell NHL, these scores were 54% and 44%, respectively. The IPI score had no prognostic value and only the following parameters adversely affected overall survival and DFS (P <.05): marrow involvement; more than one extranodal site; histology (nonanaplastic T-cell v others); and type of anthracycline (mitoxantrone v doxorubicin, for DFS only). CONCLUSION: These results suggest that ASCT can prevent relapse in patients with adverse IPI factors. However, patients presenting with a nonanaplastic T-cell phenotype, more than one extranodal site, or marrow involvement still have a higher risk of relapse. These factors should be taken into account when designing post-ASCT maintenance studies.
Authors: Steven I Park; Steven M Horwitz; Francine M Foss; Lauren C Pinter-Brown; Kenneth R Carson; Steven T Rosen; Barbara Pro; Eric D Hsi; Massimo Federico; Christian Gisselbrecht; Marc Schwartz; Lisa A Bellm; Mark Acosta; Ranjana H Advani; Tatyana Feldman; Mary Jo Lechowicz; Sonali M Smith; Frederick Lansigan; Anil Tulpule; Michael D Craig; John P Greer; Brad S Kahl; Joseph W Leach; Neil Morganstein; Carla Casulo; Andrei R Shustov Journal: Cancer Date: 2019-01-29 Impact factor: 6.860
Authors: Owen A O'Connor; Steven Horwitz; Tamás Masszi; Achiel Van Hoof; Peter Brown; Jeannette Doorduijn; Georg Hess; Wojciech Jurczak; Poul Knoblauch; Shanta Chawla; Gajanan Bhat; Mi Rim Choi; Jan Walewski; Kerry Savage; Francine Foss; Lee F Allen; Andrei Shustov Journal: J Clin Oncol Date: 2015-06-22 Impact factor: 44.544
Authors: S M Hiniker; R T Hoppe; M L Dworkin; A L Jiang; R Von Eyben; M A Spinner; R H Advani; R Lowsky Journal: Bone Marrow Transplant Date: 2021-10-20 Impact factor: 5.483