HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION COMPARED WITH MACOP-B IN AGGRESSIVE B-CELL LYMPHOMA

Background We compared a regimen of six chemotherapeutic agents admini stered sequentially at high doses, followed by myeloablative treatment and bone marrow transplantation, with a regimen of methotrexate, doxo rubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MAC OP-B) as initial or salvage treatment for adults with diffuse large-ce ll lymphoma. Methods Ninety-eight eligible patients with diffuse large -cell lymphoma of the B-cell type were randomly assigned to receive ei ther MACOP-B (50 patients) or high-dose sequential therapy (48 patient s). If the assigned treatment failed, the study design allowed patient s to cross over to the other treatment group.Results After a median fo llow-up of 55 months, the patients given high-dose sequential therapy, as compared with those treated with MACOP-B, had significantly higher rates of complete response (96 percent vs. 70 percent, P=0.001), free dom from disease progression (84 percent vs. 49 percent, P<0.001), fre edom from relapse (88 percent vs. 70 percent, P=0.055), and event-free survival (76 percent vs. 49 percent, P=0.004). The difference in over all survival at seven years, which also favored the group assigned to high-dose sequential therapy, was marginally significant (81 percent v s. 55 percent, P=0.09). Conclusions High-dose sequential therapy is su perior to standard-dose MACOP-B for patients with diffuse diffuse larg e-cell lymphoma of the B-cell type. (C) 1997, Massachusetts Medical So ciety.