Adult lymphoblastic lymphoma: Theuse of high dose strategies as salvage or post-remission therapy

Dose intensive chemo-/radio-therapv regimens produce long term disease free survival (DPS) rates of 40% to 60% in adult patients (ptsl with lymphoolastic tymphoma (LBL). Further dose intensification with high dose therapy and autologous stem cell transplantation (ASCT) in first remission has been used in several single center trials, for patients regarded as 'poor risk'. Long term DFS rites of about 70% are reported in most of these series. Between January 1980 and December 1994, 263 adurt patients with LBL, treated with high dose therapy and ASCT in first remission were reported to the rympnoma registry of the European Group for Blood and Marrow Transplantation (EBMT1. 78% had stage IH/IV disease, with BM disease in 31% and CNS + in 7%. 49% had bulky OlOcm) disease, and 67% had elevated serum LDH. The projected 6 year actuarial overall survival (OS) for this group is 64%. The EBMT and UK Lymphoma Group (UKLGI are currently conducted a randomised, prospective trial of conventional dose consolidation/maintenance therapy vs high dose therapy and ASCT for adult LBL patients in first remission after standard remission induction therapy. Between Nov 1992 and Dec 1995, 81 pts from 33 centers have been entered. Pt characteristics: male - 57, female - 24; median age (range) - 25 (14 - 62); stage I - 5, II - 18, III - 15, IV -36; B symptoms -30; T cell -49, B cell - 22.-BM + -16; WHO performance status 0 - 9, 1 36, 2 - 9, 3 6, 4 - 4; elevated LDH - 46. Remission induction therapy; modified LSA₂L₂ - 51, Stanford regimen -11, others -8. Responses to induction therapy: CR - 38, PR - 22, NR - 1, PD - 4, early death - 6, not evaluated (too early) - 1 Of 81 ots entered to date, 44 have been randomised (22 to each arm). Reasons for nonrandomisation: death on or before induction therapy - 5, allogeneic BMT -10, patient refusal - 5, others - 4. The OS for the 44 randomised pts is 55% at 18 months from the date of randomisation. No deaths have occurred > 12 months from randomisation. Analysis according to randomised arm remains confidential. Target accrual to the study is 200 randomised pts and recruitment is on-going.