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Evidence summaries

High-Dose Chemotherapy Followed by Autologous Stem Cell Transplantation (Hdt) as First-Line Therapy in Aggressive Non-Hodgkin's Lymphoma (NHL)

High-dose chemotherapy followed by autologous stem cell transplantation (HDT) is not more effective in improving overall survival in low-risk patients than control therapies (CT) as initial therapy for aggressive NHL. Poor risk patients seem to benefit from HDT, but the evidence is insufficient. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 15 studies with a total of 3 079 patients. Overall treatment-related mortality was 6.0% in the HDT group and not significantly different compared to conventional chemotherapy (OR 1.33 95% CI 0.91 to 1.93). 13 studies including 2 018 patients showed significantly higher complete tumour response (CR) rates in the group receiving HDT (OR 1.32 95% CI 1.09 to 1.59). However, HDT did not have an effect on overall survival (OS), when compared to conventional chemotherapy. The pooled hazard ratio (HR) was 1.04 (95% CI 0.91 to 1.18). Subgroup analysis of prognostic groups according to International Prognostic Index score (IPI) did not show any survival difference between HDT and controls in 12 trials (low and low-intermediate risk IPI: HR 1.41 95% CI 0.95 to 2.10; high-intermediate and high risk IPI: HR 0.97 95% CI 0.83 to 1.13. Event-free survival (EFS) also showed no significant difference between HDT and CT (HR 0.93 95% CI 0.81 to 1.07). There was no evidence for an association between other possible risk factors such as the proportion of patient with diffuse large cell lymphoma, protocol adherence, HDT strategy, response status before HDT, conditioning regimens and methodological issues and the results.

    References

    • Greb A, Bohlius J, Schiefer D, Schwarzer G, Schulz H, Engert A. High-dose chemotherapy with autologous stem cell transplantation in the first line treatment of aggressive non-Hodgkin lymphoma (NHL) in adults. Cochrane Database Syst Rev 2008 Jan 23;(1):CD004024. [PubMed]

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