Radiochemotherapy/Transplant in Low-Grade Lymphomas

 MUNICH, Germany—Patients 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 six cycles.

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 dose.

Two additional courses of MCP or CHOP followed by interferon-alfa until progression or intolerable toxicity.

Response Rates

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 therapy.