High-Dose Therapy and Autologous Bone Marrow Transplantation after Failure of Conventional Chemotherapy in Adults with Intermediate-Grade or High-Grade Non-Hodgkin's Lymphoma

Thierry Philip, James O. Armitage, Gary Spitzer, Franck Chauvin, Sundar Jagannath, Jean Yves Cahn, Philippe Colombat, Antony H. Goldstone, Norbert C. Gorin, Michel Flesh, Jean Philippe Laporte, Dominique Maraninchi, José Pico, André Bosly, Cathy Anderson, Rik Schots, Pierre Biron, Fernando Cabanillas, Karl Dicke

Research output: Contribution to journalArticlepeer-review

648 Scopus citations

Abstract

Adult patients with advanced non-Hodgkin's lymphoma in whom conventional chemotherapy has failed are seldom cured thereafter. We studied 100 such patients with intermediate-grade or high-grade non-Hodgkin's lymphoma who were subsequently treated with high-dose chemotherapy (61 patients) or high-dose chemotherapy plus total-body irradiation (39 patients), with bone marrow transplantation used for hematologic support. Thirty-four patients had disease that had been refractory to primary chemotherapy, and 66 patients had had a complete remission with primary chemotherapy but later relapsed. Before autologous bone marrow transplantation and high-dose chemotherapy, the 66 relapsed patients had also received conventional salvage chemotherapy; 22 had had no response or had had disease progression (a response termed “resistant relapse”), and 44 patients had responded partially or completely (a response termed “sensitive relapse”). After high-dose therapy and bone marrow transplantation, the actuarial three-year diseasefree survival was zero in the refractory group, 14 percent in the resistant-relapse group, and 36 percent in the sensitive-relapse group. Patients who had had a complete remission in response to initial chemotherapy had a higher disease-free survival rate than those who had not (P<0.001), and patients with sensitive relapse had a higher disease-free survival rate than those with resistant relapse (P<0.003). These results should be considered in the planning or interpretation of trials of salvage chemotherapy in adults with non-Hodgkin's lymphoma. (N Engl J Med 1987; 316:1493–8.), PATIENTS with advanced diffuse non-Hodgkin's lymphoma are rarely cured of their disease after conventional chemotherapy fails. However, experience gained in Burkitt's lymphoma has shown that these lymphomas are still sensitive to intensive chemoradiotherapy after the failure of treatment with a conventional dosage.1 2 3 4 5 6 With bone marrow transplantation providing hematologic support, it has been possible to administer intensive chemoradiotherapy and to cure some children or adults with disseminated, aggressive non-Hodgkin's lymphoma.7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Many questions about such a program remain unanswered. The issue of autologous versus allogeneic marrow rescue and, in the case of autologous bone marrow transplantation, the value of various methods of….

Original languageEnglish (US)
Pages (from-to)1493-1498
Number of pages6
JournalNew England Journal of Medicine
Volume316
Issue number24
DOIs
StatePublished - Jun 11 1987

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'High-Dose Therapy and Autologous Bone Marrow Transplantation after Failure of Conventional Chemotherapy in Adults with Intermediate-Grade or High-Grade Non-Hodgkin's Lymphoma'. Together they form a unique fingerprint.

Cite this