The VIM3-AraC regimen followed by autologous stem cell transplantation in refractory or relapsing aggressive non-Hodgkin's lymphoma. A prospective study of 71 consecutive cases

We evaluated with an intent-to-treat analysis the response rate, the diseas e-free survival (DFS), and the overall survival after a multidrug salvage r egimen (VIM3ARAC), followed by stem-cell transplantation (SCT) in case of r esponse, in patients with aggressive non-Hodgkin's lymphoma (NHL) who progr essed on or after the first-line therapy. Seventy-one patients (refractory: 15; relapse 'on therapy': 36; and relapse 'off therapy': 20) received two courses of VIM3ARAC (teniposide, ifosfamide, mitoxantrone, mitoguazone, hig h-dose methotrexate, high-dose cytarabine, prednisolone). SCT was performed only in patients with minimal disease after the second course. The respons e rate was 72%. It was not influenced by response to first-line therapy. Fo rty-eight patients (68%), including 32 complete responders, fulfilled respo nse criteria for SCT. Thirty-six patients underwent SCT (allogeneic: 3; aut ologous: 33). The 4-year DFS rate of the 48 responding patients was 39%. Th e actuarial survival at 4 years was 34% for all patients. Relapse off thera py and a performance status <2 at relapse were the only two independent fav orable prognostic factors for survival. In conclusion, VIM3AraC is associat ed with a high response rate in relapsing and refractory aggressive NHL. Up to half of the patients could receive SCT. This chemotherapy, followed by SCT could durably salvage 34% of these patients.