Early autologous stem cell transplantation resulted in improved progression-free survival in patients with high-intermediate risk or high-risk disease who experienced a response to induction therapy, according to the results of a study published in the New England Journal of Medicine.
Non-Hodgkin’s lymphoma (NHL) is a form of cancer that begins in the cells of the lymph system. It is characterized by the excessive accumulation of atypical (cancerous) lymphocytes. These lymphocytes can crowd the lymph system and suppress the formation and function of other immune and blood cells.
Stem cell transplantation (also called bone marrow transplantation) is a procedure often used to treat patients with leukemia and lymphoma. The procedure first involves the delivery of high-dose chemotherapy and/or radiation, which destroys more cancer cells than standard doses. Unfortunately, the high-dose therapy also damages normal cells—most notably, the blood-producing stem cells in the bone marrow. In order to repair this damage, a stem cell transplant is used to “rescue” or restore bone marrow blood and immune cell production. In autologous stem cell transplantation, the stem cells come from the patient—they are harvested and frozen prior to high-dose treatment.
Since the advent of a drug called Rituxan® (rituximab), researchers have not measured the efficacy of autologous stem cell transplantation during the first remission in patients with diffuse, aggressive non-Hodgkin’s lymphoma classified as high-intermediate risk or high risk on the International Prognostic Index—and the approach remains controversial.
Researchers conducted a study that included 370 eligible patients with NHL classified as high-risk or high-intermediate risk. Patients received five cycles of CHOP or R-CHOP. Those who responded were randomly assigned to the transplantation group or the control group. The transplantation group received one additional cycle of induction therapy followed by autologous stem cell transplantation. The control group received three additional cycles of induction therapy.
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The two-year progression-free survival rate was 69 percent in the transplantation group and 55 percent in the control group. Two-year overall survival rates were 71 percent in the transplantation group versus 74 percent in the control group; 37 patients in the transplantation group and 47 in the control group died. Exploratory analysis showed a different treatment effect based on risk level. Among high-risk patients, the two-year overall survival rate was 82 percent in the transplantation group and 64 percent in the control group.
The researchers concluded: “Early autologous stem-cell transplantation improved progression-free survival among patients with high-intermediate-risk or high-risk disease who had a response to induction therapy. Overall survival after transplantation was not improved, probably because of the effectiveness of salvage transplantation.”
Stiff PJ, Unger JM, Cook JR, et al. Autologous transplantation as consolidation for aggressive non-Hodgkin’s lymphoma. New England Journal of Medicine. 2013; 369:1681-1690.
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