Prognostic value of the age-adjusted International Prognostic Index in chemosensitive recurrent or refractory non-Hodgkin's lymphomas treated with high-dose BEAM therapy and autologous stem cell transplantation

• Published in: Leukemia & lymphoma 2005-06, Vol.46 (6), p.861-867
• Main Authors: Jabbour, E, Peslin, N, Arnaud, P, Ferme, C, Carde, P, Vantelon, JM, Bocaccio, C, Bourhis, JH, Koscielny, S, Ribrag, V
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; BEAM; Carmustine - therapeutic use; Cyclophosphamide - therapeutic use; Cytarabine - therapeutic use; Doxorubicin - therapeutic use; Etoposide - therapeutic use; Female; high-dose therapy; Humans; IPI lymphoma; lymphoma; Lymphoma, Non-Hodgkin - diagnosis; Lymphoma, Non-Hodgkin - immunology; Lymphoma, Non-Hodgkin - therapy; Male; Medical Oncology - standards; Melphalan - therapeutic use; Middle Aged; Prednisolone - therapeutic use; Prognosis; prognostic factor; Recurrence; Remission Induction; salvage chemotherapy; Stem Cell Transplantation - methods; Transplantation, Autologous; Vincristine - therapeutic use
• ISSN: 1042-8194; 1029-2403
• DOI: 10.1080/10428190500054350

High-dose therapy (HDT) is now recommended for patients under 60 years of age with chemosensitive relapsed aggressive non-Hodgkin's lymphoma. However, approximately half of these patients will be cured by HDT. Prognostic factors are needed to predict which patients with chemosensitive lymphoma to second-line therapy could benefit from HDT. We retrospectively investigated the prognostic value of the widely used age-adjusted International Prognostic Index (AA-IPI) calculated at the time of relapse (35 patients) or just before second-line salvage therapy for primary refractory disease (5 patients). The median age was 51 years (range 18-64 years). Thirty-six patients had diffuse large B-cell lymphoma. Salvage cytoreductive therapy before HDT was DHAP/ESHAP (cytarabine, cysplatin, etoposide, steroids) in 17 patients, VIM3-Ara-c/MAMI (high-dose cytarabine, ifosfamide, methyl-gag, amsacrine) in 17 patients, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or reinforced CHOP in 4 patients, high-dose cyclophosphamide and etoposide in 2 patients. The HDT regimen consisted of BEAM (carmusine, cytarabine, etoposide, melphalan) in all cases. Eleven patients were in partial remission and 29 in complete remission at the time of HDT. Ten patients had an IPI >1, 16 had relapsed early (6 months after first-line chemotherapy) (P=1), but the AA-IPI >1 was associated with a poor outcome (P=0.03). In conclusion, the AA-IPI could have a prognostic value in patients with chemosensitive recurrent lymphoma treated with BEAM HDT.