Patients with aggressive non-Hodgkin's lymphoma do just as well when they are given standard chemotherapy for first line treatment as they do when they are treated with high dose chemotherapy and receive a bone marrow transplant, a new study shows.
The findings suggest that the more powerful and risky treatment of high dose chemotherapy followed by autologous bone marrow transplant should be reserved for patients in whom other treatments have failed, according to lead author Dr Hanneke Kluin-Nelemans of Leiden University Medical Centre in the Netherlands and colleagues (Journal of the National Cancer Institute 2001;93:4-5, 22-30).
Last year, the only trial showing that bone marrow transplants for breast cancer could prolong life was discredited after the study's lead investigator was accused of serious scientific misconduct. Previously, the results of four breast cancer studies comparing high dose chemotherapy plus either bone marrow or stem cell transplant with standard chemotherapy found no extra benefit from the more aggressive treatment (BMJ 2000;320:398).
In the current study the researchers randomised nearly 200 patients aged 15-65 with stage II-IV non-Hodgkin's lymphoma either to receive an autologous bone marrow transplant or to be in a control arm in the trial. The patients had all already received three cycles of a drug regimen known as CHVmP/BV, which combines cyclophosphamide, doxorubicin, teniposide, and prednisone, with bleomycin and vincristine added at mid-cycle.
Of the 194 participants, 140 were of low or low to intermediate risk according to the international prognostic index. Participants in the group receiving a bone marrow transplant received another three cycles of CHVmP/BV, followed by a regimen known as BEAC, which is a combination of carmustine, etoposide, cytarabine, and cyclophosphamide. The controls received five more cycles of CHVmP/BV.
Follow up at 53 months showed that 61% of the participants who received a bone marrow transplant were free of disease progression and 68% were still alive; in the control group the corresponding proportions were 56% and 77%. The difference between the two groups was not significant, and therefore no benefit from the combination therapy and bone marrow transplant can be inferred.
Dr Richard Fisher, professor of medicine at Loyola University in Chicago, Illinois, wrote in an accompanying editorial that there seemed to be no indication to add autologous bone marrow transplant plus high dose chemotherapy to the initial combination chemotherapy for all patients with aggressive lymphoma.
Scott Gottlieb New York
COPYRIGHT 2001 British Medical Association
COPYRIGHT 2001 Gale Group
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