Long-Term Follow-up High-Dose Chemotherapy (Drug-Only Program) Followed by Autologous Stem Cell Transplantation for Aggressive Non-Hodgkin's Lymphomas

• Published in: Clinical lymphoma 2005-06, Vol.6 (1), p.31-36
• Main Authors: Usui, Noriko, Yano, Shingo, Asai, Osamu, Dobashi, Nobuaki, Osawa, Hiroshi, Takei, Yutaka, Sugiyama, Katsuki, Takahara, Shinobu, Otubo, Hiroko, Saito, Takeshi, Okawa, Yutaka, Hagino, Takeshi, Kaito, Ken, Kobayashi, Masayuki
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin; Combined Modality Therapy; Cyclophosphamide; Cyclophosphamide - therapeutic use; Disease-Free Survival; Doxorubicin - therapeutic use; Etoposide; Female; Humans; Involved-field radiation therapy; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - pathology; Lymphoma, Non-Hodgkin - therapy; Male; Middle Aged; Nimustine; Prednisone - therapeutic use; Stem Cell Transplantation; Survival Analysis; Transplantation, Autologous; Vincristine - therapeutic use
• ISSN: 1526-9655; 2331-4486
• DOI: 10.3816/CLM.2005.n.024

To investigate the feasibility of high-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) for aggressive non-Hodgkin's lymphoma (NHL), we conducted HDCT with ASCT using a drug-only protocol without total body irradiation. Previously untreated and treated adult patients with aggressive lymphoma were enrolled onto this study. For the HDCT protocol, we developed the AECC regimen, a drug-only regimen consisting of etoposide, carboplatin, cyclophosphamide, and nimustine (ie, ACNU). Mobilized peripheral blood stem cells were used mainly as a source for ASCT and were used based on collection rates of CD34 cells. Fifty-six patients were enrolled and assessed for this study. The median length of follow-up was 6.5 years, with a range of 0.2–12.5 years. Retrospective immunophenotypic examination indicated that the majority of the patients were diagnosed with B-cell lymphoma. Before HDCT, 37 patients still had disease (26 partial responses [PRs] and 11 cases of no response), and 19 patients exhibited a complete response (CR) before HDCT with ASCT. Among 56 patients, 37 (66%) exhibited a CR, including patients continuing their first CR and those experiencing a second or further CR, and 11 patients (19.6%) exhibited PR on HDCT with ASCT. Outcomes of patients without CR were significantly poorer than those of the patients with CR, and 7-year overall survival rates of patients with and without CR were 63% and 27.2%, respectively. No patients developed a second malignancy, including leukemia or myelodysplastic syndrome. High-dose chemotherapy followed by ASCT is one of the available consolidation therapies for aggressive NHL, and additional involved-field irradiation could play a role in the management of patients with NHL who do not exhibit a CR after treatment with HDCT containing a drug-only program.