Study of conditioning regimens with or without high-dose radiotherapy before autologous stem cell transplantation for treating aggressive lymphoma
First Online: 10 December 2008 Received: 03 April 2008 Revised: 16 October 2008 Accepted: 05 November 2008 DOI:
Cite this article as: Niu, Y., Shi, Y., Zhou, S. et al. Int J Hematol (2009) 89: 106. doi:10.1007/s12185-008-0217-x Abstract
The aim and objective of the study is to compare the efficacy of conditioning regimens with or without high-dose radiotherapy for treating aggressive non-Hodgkin’s lymphoma (NHL). Eighty-nine aggressive NHL patients who underwent high-dose therapy in combination with autologous stem cell transplantation (HDT/ASCT) between 1993 and 2006 were retrospectively studied. HDT was either high-dose chemotherapy alone (CT) or high-dose chemoradiotherapy (CRT). Overall, 37 patients in CT group and 52 in CRT group. The median radiotherapy DT in CRT group was 8 Gy. The median count of reinfused CD34+ cells was 6.26 × 10
6 and 22.16 × 10 6 cells/kg, respectively ( p < 0.001). The median time of leukocyte engraftment was 11 days in CT group and 13 days in CRT group ( p = 0.003), and the median platelet engraftment time was 12 days in CT group and 11 days in CRT group ( p = 0.305). The median event-free survival (EFS) was 102 and 84 months in CT and CRT groups, respectively ( p = 0.783), and the median overall survival (OS) was 102 and 121 months in CT and CRT groups, respectively ( p = 0.857). Prolonged hospitalization favored EFS ( p = 0.013) and OS ( p = 0.011). In conclusion, when compared with CT, high-dose CRT does not improve prognosis. Keywords High-dose therapy in combination with autologous stem-cell transplantation Aggressive non-Hodgkin’s lymphoma Conditioning regimen Radiotherapy References
Stiff P, Dahlberg S, Forman S, et al. Autologous bone marrow transplantation for patients with relapsed or refractory diffuse aggressive non-Hodgkin’s lymphoma: value of augmented preparative regimens—a Southwest Oncology Group trial. J Clin Oncol. 1998;16:48–55.
Philip T, Guglielmi C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. N Engl J Med. 1995;333:1540–5. doi:
Rodriguez J, Caballero MD, Gutierrez A, et al. Autologous stem-cell transplantation in diffuse large B-cell non-Hodgkin’s lymphoma not achieving complete response after induction chemotherapy: the GEL/TAMO experience. Ann Oncol. 2004;15:1504–9. doi:
Xh He, Yk Shi, Xh Han, et al. Autologous peripheral blood stem cell transplantation in the treatment of patients with primary large mediastinal B-cell lymphoma. Chin J Oncol. 2003;25(6):592–5.
Josting A, Reiser M, Rueffer U, Salzberger B, Diehl V, Engert A. treatment of primary progressive Hodgkin’s and aggressive non-Hodgkin’s lymphoma: is there a chance for cure? J Clin Oncol. 2000;18:332–9.
Kewalramani T, Zelenetz AD, Hedrick EE, et al. High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis. Blood. 2000;96(7):2399–404.
Aristei C, Tabilio A. Total-body irradiation in the conditioning regimens for autologous stem cell transplantation in lymphoproliferative diseases. Oncologist. 1999;4:386–97.
Portlock CS, Rosenberg SA, Glatstein E. Kaplan HS: treatment of advanced non-hodgkin’s lymphomas with favorable histologies: preliminary results of a prospective trial. Blood. 1976;47(5):747–56.
Ketterer N, Salles G, Raba M, et al. High CD34+ cell counts decrease hematologic toxicity of autologous peripheral blood progenitor cell transplantation. Blood. 1998;91(9):3148–55.
Armitage JO, Carbone PP, Connors JM, Levine A, Bennett JM, Kroll S. Treatment-related myelodysplasia and acute leukemia in non-Hodgkin’s lymphoma patients. J Clin Oncol. 2003;21:897–906. doi:
Brown JR, Yeckes H, Friedberg JW, et al. Increasing incidence of late second malignancies after conditioning with cyclophosphamide and total-body irradiation and autologous bone marrow transplantation for non-Hodgkin’s lymphoma. J Clin Oncol. 2005;23:2208–14. doi:
Park S, Brice P, Noguerra M, et al. Myelodysplasias and leukemias after autologous stem cell transplantation for lymphoid malignancies. Bone Marrow Transplant. 2000;26:321–6. doi:
Bhatia S, Ramsay NKC, Steinbuch M, et al. Malignant neoplasms following bone marrow transplantation. Blood. 1996;87(9):3633–9.
Verdonck LF, WLJv Putten, Hagenbeek A, et al. Comparison of CHOP chemotherapy with autologous bone marrow transplantation for slowly responding patients with aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1995;332(16):1045–51. doi:
Blay J-Y, Gomez F, Sebban C, et al. The international prognostic index correlates to survival in patients with aggressive lymphoma in relapse: analysis of the PARMA trial. Blood. 1998;92(10):3562–8.
Vose JM, Zhang MJ, Rowlings PA, et al. Autologous transplantation for diffuse aggressive non-Hodgkin’s lymphoma in patients never achieving remission: a report from the autologous blood and marrow transplant registry. J Clin Oncol. 2001;19:406–13.
Milpied N, Deconinck E, Gaillard F, et al. Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med. 2004;350(13):1287–95. doi:
Haioun C, Lepage E, Gisselbrecht C, et al. 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. J Clin Oncol. 2000;18(16):3025–30.
Kluin-Nelemans HC, Zagonel V, Anastasopoulou A, et al. Standard chemotherapy with or without high-dose chemotherapy for aggressive non-hodgkin’s lymphoma: randomized phase III EORTC study. J Natl Cancer Inst. 2001;93(1):22–30. doi:
Greb A, Bohlius J, Trelle S, et al. High-dose chemotherapy with autologous stem cell support in first-line treatment of aggressive non-Hodgkin lymphoma—results of a comprehensive meta-analysis. Cancer Treat Rev. 2007;33(4):338–46. doi:
Liu K, Lu D. Clinical analysis of autologous peripheral blood stem cell transplantation in 182 patients with non-Hodgkin’s lymphoma. Chin J Oncol. 2002;41(6):363–6.
Hamlin PA, Zelenetz AD, Kewalramani T, et al. Age-adjusted international prognostic index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma. Blood. 2003;102(6):1989–96.
Zhou L, Sun Y, Tan W, et al. The clinical, pathological analysis for 1125 cases with non—Hodgkin’s lymphoma. Oncol Prog. 2006;4(5):391–7.
© The Japanese Society of Hematology 2008