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First-Line Transplant Benefits NHL Patients

First-Line Transplant Benefits NHL Patients

ORLANDO—Preliminary results of a French study show improved event-free
survival for patients with indolent non-Hodgkin’s lymphoma (NHL) who received
high-dose chemotherapy with purged autologous stem cell transplantation as
first-line therapy, compared with conventional standard therapy.

Eric Deconinck, MD, of Besançon University Hospital, and his associates in
the GOELAMS group, reported the preliminary findings of the multicenter
randomized phase III study at the 43rd Annual Meeting of the American Society
of Hematology (ASH abstract 3573).

At the time of the ASH meeting, the GOELAMS 064 protocol, begun in April
1994, had enrolled 172 patients (age 18 to 60) with newly diagnosed stage II
bulky or stage III/IV follicular lymphoma and at least one criteria of high
tumor burden. Stage IV NHL was diagnosed in 70% of patients. A total of 144
patients had been analyzed at the time of the ASH presentation, and 124 were
evaluable.

Sixty-six patients received standard CHVP (cyclophosphamide, doxorubicin,
teniposide, prednisone) chemotherapy plus interferon-alfa-2b (IFN, Intron A) at
a dose of 5 × 106 three times a week. They received CHVP monthly for 6 months,
then every other month for a total of 12 courses over 18 months.

Fifty-eight patients randomized to high-dose therapy/transplant received
three cycles of VCAP (vindesine 3 mg/m² on day 1, cyclophosphamide 1,500
mg/m² on day 2, Adriamycin 80 mg/m² on day 2, and prednisolone 80 mg/m² on days
1 to 5).

The 43 patients in complete or very good partial remission were mobilized
after the second or third VCAP cycle with one cycle of IMVP16 (ifosfamide,
methotrexate, etoposide). The 15 patients in partial remission or relapse
received two cycles of DHAP (dexamethasone, cytarabine, cisplatin) before
harvest and stem cell transplant if possible.

Peripheral blood stem cells or bone marrow was harvested followed by B cell
purging via negative selection (with immunomagnetic beads) or positive
selection (with CD34+ selection).

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