SURVIVAL BENEFIT FRONT HIGH-DOSE THERAPY WITH AUTOLOGOUS BLOOD PROGENITOR-CELL TRANSPLANTATION IN POOR-PROGNOSIS NON-HODGKINS-LYMPHOMA

Purpose: To compare standard and intensive treatment strategies for pa tients with high-grade non-Hodgkin's lymphoma (NHL) of poor prognosis, defined by the international prognostic index. Patients and Methods: Thirty-four patients received standard chemotherapy with 11 weeks of d oxorubicin, cyclophosphamide, vincristine, bleomycin, etoposide, predn isolone, and methotrexate (VAPEC-B), and 33 received intensive treatme nt with 7 weeks of VAPEC-B, three cycles of ifosfamide/cytarabine, the n high-dose busulfan/cyclophosphamide followed by autologous blood pro genitor-cell (BPC) transplantation. Results: Twelve of 33 patients in the intensive group and 26 of 34 patients in the standard group have d ied. The median follow-vp time for the surviving patients is 31 months and 68 months, respectively. At 2 years, the actuarial estimates of e vent-free survival (EFS) were 61% versus 35% (P =.01) and of overall s urvival, 64% versus 35% (P =.01). A significant reduction in the event rate (progression or death) was maintained after adjustment for age a nd the number of risk factors. The estimated risk of experiencing an e vent was 0.37 (95% confidence interval [CI], 0.16 to 0.84) in the inte nsive group compared with the standard group. Conclusion: Patients wit h poor prognostic features who received high-dose therapy and BPC resc ue had a superior EFS. The survival differences observed in this study justify a formal comparison in a randomized study. (C) 1996 by Americ an Society of Clinical Oncology.