LOS ANGELES--The final report of the Parma study, presented at
the American Society of Clinical Oncology meeting, confirms the
superiority of dose intensification with autologous bone marrow
transplantation (ABMT) over conventional chemotherapy in patients
with relapsed diffuse non-Hodgkin's lymphoma (NHL).
"High-dose chemotherapy with ABMT increases both event-free
survival and overall survival and can be considered as standard
treatment of high- and intermediate-grade NHL in sensitive relapse,"
Thierry O. Philip, MD, director of the Centre Leon Berard, Lyon,
France, said in his report at the plenary session.
Although ABMT has been widely used in these patients for nearly
two decades, results of previous studies had been questioned primarily
because of lack of uniform patient selection criteria and inability
to prove survival benefit. At a 1985 meeting in Parma, Italy,
a protocol for a definitive prospective randomized multicenter
study was developed.
The criteria were designed to select patients most likely to be
cured with chemotherapy, Dr. Philip said. The protocol was open
to patients with diffuse high- or intermediate-grade lymphoma
in first or second relapse who had a previous complete response
with an Adriamycin-containing regimen. Patients over 60 years
of age and those with CNS or bone marrow involvement were excluded
from the trial.
The study began with 216 patients who received two courses of
DHAP (dexamethasone, ara-C, and cisplatin). Those in partial or
complete response were then defined as sensitive relapses, and
all others were defined as resistant relapses and were excluded
from the study.
Those patients in sensitive relapse (109 eligible) were then randomized
to receive either conventional treatment (four additional courses
of DHAP followed by involved-field radiotherapy) or dose-intensive
therapy consisting of involved-field radiotherapy plus high-dose
chemotherapy--BCNU, etoposide, ara-C, and cyclophosphamide (BEAC)--followed
by ABMT. In both arms, patients received radiotherapy only if
one or more relapsed tumor sites measured more than 5 cm.
Response rates were significantly higher with ABMT (84% versus
45% for conventional DHAP), as were complete responses (78% vs
40%). At a median of 63 months of follow-up, disease-free survival
was 46% for the transplant patients, compared with 12% for the