• Reyes Arranz, Eulogio Conde, Carlos Grande, Maria Victoria Mateos, Marco Gandarillas, Carmen Albo, Juan J Lahuerta, José M Fernández-Rañada, Miguel T Hernández, Natalia Alonso, José A García Vela, Sebastián Garzón, José Rodríguez, Dolores Caballero, and Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL-TAMO).
• Hospital Universitario de La Princesa, Madrid, Spain. rarranzs@telefonica.net
• Eur. J. Haematol. 2008 Mar 1; 80 (3): 227-35.

ObjectivesThe role of high-dose therapy and autologous stem-cell transplantation (HDT/ASCT) in the up-front treatment of poor-risk aggressive lymphoma is still unknown. We conducted a prospective multi-centre trial with dose-escalated CHOP (MegaCHOP) and tailored intensification prior to HDT/ASCT according to early response assessed by CT and gallium scan (Ga67S).Patients And MethodsEighty-six patients with newly diagnosed and Ga-67 avid aggressive B-cell lymphoma received MegaCHOP for three courses and were evaluated for response by CT and Ga67S. Patients with CT response and negative Ga67S received another MegaCHOP cycle followed by BEAM and ASCT. Those patients with positive Ga67S or without CT response received salvage treatment with two courses of ifosfamide and etoposide (IFE) followed, whenever response had been achieved, by BEAM and ASCT.ResultsResponse rate before HDT/ASCT was 85% and, with 34 months of median follow-up, progression-free survival (PFS), overall survival (OS) and treatment-related mortality were 56%, 64% and 7%, respectively. For transplanted patients (81% of the whole series), PFS and OS were 67% and 74%, respectively. No different outcomes were observed between patients achieving an early negative Ga67S response treated with MegaCHOP and BEAM/ASCT and patients with mid-treatment positive Ga67S who received IFE prior BEAM/ASCT.ConclusionsThis response-adapted strategy including early treatment modifications prior HDT/ASCT have yielded encouraging PFS and OS in patients with poor-risk B aggressive non-Hodgkin's lymphoma.

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