How do patients with aggressive non-Hodgkin's lymphoma treated with third-generation regimens fare in the long-term?

Background and Objectives. To examine the long-term clinical course and pro gnostic factors of patients with advanced aggressive non-Hodgkin's lymphoma (NHL) treated with third-generation regimens as front-line chemotherapy. Design and Methods. A total of 348 patients aged <60 years received MACOP-B or F-MACHOP regimen between September 1988 and August 1993 for advanced st age aggressive NHL. Results. Of these, 249 (71.5%) obtained a complete response (CR); 65/249 (2 6%) subsequently relapsed. the CR rates for MACOP-B and F-MACHOP were 70.5% and 72%, respectively, while the relapse-free survival rates (RFS) at 9 ye ars were 66% and 74%, respectively. The overall survival rate at 9 years wa s 61% for MACOP-B and 67% for F-MACHOP patients. Of the relapses, 78.5% wer e early (<24 months) and 21.5% late. Eleven out of 65 (17%) patients are in continuous second CR with a median follow-up of 45 months; most of them ha ve been salvaged with high-dose therapies. The validity of the Internationa l Prognostic Index was confirmed in long-term analysis. Interpretation and Conclusions. With a 9-year RFS, it is possible to consid er cured 50% of the patient with aggressive NHL treated with a third-genera tion regimen. About a quarter of the CRs relapse and late relapse occurs in roughly 20% of all relapsed patients. In these patients high-dose chemothe rapy followed by autologous bone marrow or hematopoietic stem cell transpla ntation seems to be a very reliable approach in terms of long-term second O n. Finally, the IPI score maintains its pivotal role in terms of stratifyin g patients according to different risk subsets also in long-term analysis. (C) 1999, Ferrata Storti Foundation.