MUNICH, GermanyPatients with low-grade lymphoma had a
longer disease-free interval when they received radiochemotherapy and
stem cell transplant than when they were maintained on
interferon-alfa, Wolfgang Hiddemann, MD, PhD, said at the American
Society of Hematology annual meeting.
Dr. Hiddemann, professor of medicine, University of Munich, described
a study conducted by the German Low Grade Lymphoma Study Group (GLSG).
The GLSG compared two approaches to cytoreduction and two approaches
to maintenance. In the cytoreduction phase, patients with
advanced-stage low-grade lymphomas were randomized to one of two groups:
MCP (mitoxantrone, chlorambucil, prednisone) for four to six cycles.
CHOP (cyclophosphamide, doxorubicin, Oncovin, prednisone) for four to
Patients who had at least a partial remission were then randomized to
one of two groups for maintenance therapy:
Myeloablative radiochemotherapy consisting of DexaBEAM
(dexamethasone, carmustine, etoposide, cytarabine, melphalan)
followed by fractionated total body irradiation with 12 Gy over 3
days and cyclophosphamide at 60 mg/kg/d on 2 days, with autologous
stem cell transplantation 2 days after the final cyclophosphamide
Two additional courses of MCP or CHOP followed by interferon-alfa
until progression or intolerable toxicity.
Response during the cytoreduction phase could be evaluated among 269
patients. About 75% of the MCP group and 90% of the CHOP group had a
partial or complete response. In addition, stem cells were harvested
successfully in far more patients in the CHOP group (95%) than in the
MCP group (39%).
After 3 years, progression-free survival was significantly higher for
the transplant group (59%) than for the interferon-alfa group (24%).
Each group had one suicide, and the transplant group also had two
deaths from sepsis. There have been no significant differences in
overall survival so far.
Dr. Hiddemann concluded that CHOP was superior to MCP for
cytoreductive therapy, and that myeloablative radio-chemotherapy with
stem cell transplantation was superior to interferon-alfa maintenance