THE INTERNATIONAL PROGNOSTIC INDEX CORRELATES TO SURVIVAL IN PATIENTSWITH AGGRESSIVE LYMPHOMA IN RELAPSE - ANALYSIS OF THE PARMA TRIAL

The objectives of the present study were to investigate the prognostic Value of the International Prognostic Index (IPI) at relapse in the 2 15 patients with intermediate- or high-grade non-Hodgkin's lymphoma (N HL) included in the PARMA trial. The IPI at relapse was available in 2 04 (95%) of these patients. Response rates to 2 courses of DHAP were 7 7%, 54%, 55%. and 42% in patients with an IPI of 0, 1, 2 and 3, respec tively (P < .02), whereas complete response (CR) rates were 33%, 29%, 20%, and 0% in the same groups of patients (P < .03). With a median fo llow-up period of 79 months, overall survival (OS) at 5 years was 46%, 25%, 25%. and 11% in these four groups (P < .001). One hundred nine p atients responding to 2 courses of DHAP were randomized to receive eit her BEAC (carmustine, etoposide, cytarabine, cyclophosphamide and mesn a) followed by autologous bone marrow transplantation (ABMT) or 4 addi tional courses of DHAP: IPI at relapse was found highly correlated to OS in patients treated in the DHAP arm (5-year OS: 48%, 21%, 33%, and 0% for IPI 0, 1, 2, and 3, respectively; P = .006), but not in the BEA C arm (5-year OS: 51%, 47%, 50%, and 50% for IPI 0, 1, 2, and 3, respe ctively; P = .90). OS was significantly superior in the BEAC arm as co mpared with the DHAP arm in patients with an IPI >0 (P < .05), but not in patients with an IPI of 0. In conclusion, these results show that IPI correlates to response and overall survival in patients with aggre ssive NHL in relapse and enables us to identify patients with a signif icantly different outcome among those treated with conventional chemot herapy alone. (C) 1998 by The American Society of Hematology.