Standard Chemotherapy is Superior to High-dose Chemotherapy with Autologous Stem Cell Transplantation on Overall Survival As the First-line Therapy for Patients with Aggressive Non-Hodgkin Lymphoma: a Meta-analysis

Overview

Journal Med Oncol

Publisher Springer

Specialty Oncology

Date 2010 Apr 8

PMID 20373054

Citations 1

Authors

Jing Wang

Ping Zhan

Jian Ouyang

Bing Chen

Rongfu Zhou

Yonggong Yang

Affiliations

Soon will be listed here.

Abstract

Randomized controlled trials (RCTs) have reported conflicting results on the impact of high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDCT) as the first-line treatment for patients with aggressive non-Hodgkin lymphoma (NHL). We performed a systematic meta-analysis to assess the efficacy of HDCT compared to conventional chemotherapy in patients with aggressive NHL with regard to overall survival (OS) at 3 years. We gathered the data for our analysis from MEDLINE, EMBASE, Cochrane controlled trials register, Cochrane Library, and Science Citation Index (1/1990 to 11/2008) searches. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random effect model. Fourteen RCTs were identified that were published in full text and included a total of 2,413 patients. There was evidence that HDCT showed decreased OS (HR 1.20, 95% CI 1.05-1.37, P=0.006) at 3 years when compared with conventional chemotherapy. The variation in OS probabilities between studies was not statistically significant (test for heterogeneity, Q=10.14, df=13, P=0.683). Thus, our meta-analysis showed that HDCT in aggressive non-Hodgkin lymphoma had decreased overall survival outcome compared with conventional chemotherapy.

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References

Martelli M, Vignetti M, Zinzani P, Gherlinzoni F, Meloni G, Fiacchini M . High-dose chemotherapy followed by autologous bone marrow transplantation versus dexamethasone, cisplatin, and cytarabine in aggressive non-Hodgkin's lymphoma with partial response to front-line chemotherapy: a prospective randomized italian.... J Clin Oncol. 1996; 14(2):534-42. DOI: 10.1200/JCO.1996.14.2.534. View

Baldissera R, Nucci M, Vigorito A, Maiolino A, Simoes B, Lorand-Metze I . Frontline therapy with early intensification and autologous stem cell transplantation versus conventional chemotherapy in unselected high-risk, aggressive non-Hodgkin's lymphoma patients: a prospective randomized GEMOH report. Acta Haematol. 2006; 115(1-2):15-21. DOI: 10.1159/000089460. View

Betticher D, Martinelli G, Radford J, Kaufmann M, Dyer M, Kaiser U . Sequential high dose chemotherapy as initial treatment for aggressive sub-types of non-Hodgkin lymphoma: results of the international randomized phase III trial (MISTRAL). Ann Oncol. 2006; 17(10):1546-52. DOI: 10.1093/annonc/mdl153. View

Kluin-Nelemans H, Zagonel V, Anastasopoulou A, Bron D, Roozendaal K, Noordijk E . Standard chemotherapy with or without high-dose chemotherapy for aggressive non-Hodgkin's lymphoma: randomized phase III EORTC study. J Natl Cancer Inst. 2001; 93(1):22-30. DOI: 10.1093/jnci/93.1.22. View

Fanin R, Silvestri F, Geromin A, Infanti L, Sperotto A, Cerno M . Autologous stem cell transplantation for aggressive non-Hodgkin's lymphomas in first complete or partial remission: a retrospective analysis of the outcome of 52 patients according to the age-adjusted International Prognostic Index. Bone Marrow Transplant. 1998; 21(3):263-71. DOI: 10.1038/sj.bmt.1701081. View

Verdonck L, van Putten W, Hagenbeek A, Schouten H, Sonneveld P, van Imhoff G . Comparison of CHOP chemotherapy with autologous bone marrow transplantation for slowly responding patients with aggressive non-Hodgkin's lymphoma. N Engl J Med. 1995; 332(16):1045-51. DOI: 10.1056/NEJM199504203321601. View

Berlin J, Laird N, Sacks H, CHALMERS T . A comparison of statistical methods for combining event rates from clinical trials. Stat Med. 1989; 8(2):141-51. DOI: 10.1002/sim.4780080202. View

Kim S, Tanimoto T, Hirabayashi N, Goto S, Kami M, Yoshioka S . Myeloablative allogeneic hematopoietic stem cell transplantation for non-Hodgkin lymphoma: a nationwide survey in Japan. Blood. 2006; 108(1):382-9. DOI: 10.1182/blood-2005-02-0596. View

Gisselbrecht C, Lepage E, Molina T, Quesnel B, Fillet G, Lederlin P . Shortened first-line high-dose chemotherapy for patients with poor-prognosis aggressive lymphoma. J Clin Oncol. 2002; 20(10):2472-9. DOI: 10.1200/JCO.2002.02.125. View

10.

Wheatley K . Current controversies: which patients with acute myeloid leukaemia should receive a bone marrow transplantation?--a statistician's view. Br J Haematol. 2002; 118(2):351-6. DOI: 10.1046/j.1365-2141.2002.03696.x. View

11.

Philip T, Guglielmi C, Hagenbeek A, Somers R, van der Lelie H, Bron D . Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med. 1995; 333(23):1540-5. DOI: 10.1056/NEJM199512073332305. View

12.

Nademanee A, Molina A, ODonnell M, Dagis A, Snyder D, Parker P . Results of high-dose therapy and autologous bone marrow/stem cell transplantation during remission in poor-risk intermediate- and high-grade lymphoma: international index high and high-intermediate risk group. Blood. 1997; 90(10):3844-52. View

13.

Santini G, Salvagno L, Leoni P, Chisesi T, de Souza C, Sertoli M . VACOP-B versus VACOP-B plus autologous bone marrow transplantation for advanced diffuse non-Hodgkin's lymphoma: results of a prospective randomized trial by the non-Hodgkin's Lymphoma Cooperative Study Group. J Clin Oncol. 1998; 16(8):2796-802. DOI: 10.1200/JCO.1998.16.8.2796. View

14.

Martelli M, Gherlinzoni F, De Renzo A, Zinzani P, De Vivo A, Cantonetti M . Early autologous stem-cell transplantation versus conventional chemotherapy as front-line therapy in high-risk, aggressive non-Hodgkin's lymphoma: an Italian multicenter randomized trial. J Clin Oncol. 2003; 21(7):1255-62. DOI: 10.1200/JCO.2003.01.117. View

15.

Cortelazzo S, Rossi A, Bellavita P, Oldani E, Viero P, Buelli M . Clinical outcome after autologous transplantation in non-Hodgkin's lymphoma patients with high international prognostic index (IPI). Ann Oncol. 1999; 10(4):427-32. DOI: 10.1023/a:1008338607231. View

16.

Greb A, Bohlius J, Trelle S, Schiefer D, De Souza C, Gisselbrecht C . High-dose chemotherapy with autologous stem cell support in first-line treatment of aggressive non-Hodgkin lymphoma - results of a comprehensive meta-analysis. Cancer Treat Rev. 2007; 33(4):338-46. DOI: 10.1016/j.ctrv.2007.02.002. View

17.

Intragumtornchai T, Prayoonwiwat W, Numbenjapon T, Assawametha N, OCharoen R, Swasdikul D . CHOP versus CHOP plus ESHAP and high-dose therapy with autologous peripheral blood progenitor cell transplantation for high-intermediate-risk and high-risk aggressive non-Hodgkin's lymphoma. Clin Lymphoma. 2001; 1(3):219-25. DOI: 10.3816/clm.2000.n.018. View

18.

Villanueva M, Vose J . The role of hematopoietic stem cell transplantation in non-Hodgkin lymphoma. Clin Adv Hematol Oncol. 2006; 4(7):521-30. View

19.

Freedman A, Takvorian T, Neuberg D, Mauch P, Rabinowe S, Anderson K . Autologous bone marrow transplantation in poor-prognosis intermediate-grade and high-grade B-cell non-Hodgkin's lymphoma in first remission: a pilot study. J Clin Oncol. 1993; 11(5):931-6. DOI: 10.1200/JCO.1993.11.5.931. View

20.

Kaiser U, Uebelacker I, Abel U, Birkmann J, Trumper L, Schmalenberg H . Randomized study to evaluate the use of high-dose therapy as part of primary treatment for "aggressive" lymphoma. J Clin Oncol. 2002; 20(22):4413-9. DOI: 10.1200/JCO.2002.07.075. View