Role of Autologous Stem Cell Transplant in High-Risk NHL


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As described in the December 15 issue of The ASCO Post, Stiff and colleagues treated patients with high-intermediate– or high-risk diffuse, aggressive non-Hodgkin lymphoma with five cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP plus rituximab (Rituxan). Patients with at least a partial response were randomly assigned to three additional cycles of therapy or one additional cycle followed by autologous stem cell transplantation.1

Current guidelines recommend autologous stem cell transplantation for medically fit patients not in complete remission after induction chemotherapy.2 High-intermediate– or high-risk patients have a complete response rate of 55% and 44% respectively. Hence, approximately 50% of patients would have required a stem cell transplant in any case.3

Characteristics of response (partial or complete) after five cycles of chemotherapy were not mentioned in the report by Stiff et al. This could certainly have confounded the results if they were imbalanced. Response criteria aimed at standardizing terminology for complete and partial responses were available in 1999,4 when this study started enrolling patients.

At this point, a more clinically relevant question concerns the benefit of autologous stem cell transplantation in high-intermediate–risk and high-risk patients in complete remission after induction therapy, since patients not in complete remission will likely proceed to transplant. ■

—Sameer A. Mahesh, MD
Summa Health System
Akron, Ohio

Disclosure: Dr. Mahesh reported no potential conflicts of interest.

References

1. Stiff PJ, Unger JM, Cook JR, et al: Autologous transplantation as consolidation for aggressive non-Hodgkin’s lymphoma. N Engl J Med 369:1681-1690, 2013.

2. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin’s lymphomas. Version 2.2013. Available at www.nccn.org.

3. A predictive model for aggressive non-Hodgkin’s lymphoma. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. N Engl J Med 329:987-994, 1993.

4. Cheson BD, Horning SJ, Coiffier B, et al: Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol 17:1244, 1999.



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