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
I. Plantier-colcher et al., 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, LEUKEMIA, 13(2), 1999, pp. 282-288
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.