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Parma international protocol: pilot study of DHAP followed by involved-
field radiotherapy and BEAC with autologous bone marrow transplantation
T Philip, F Chauvin, J Armitage, D Bron, A Hagenbeek, P Biron, G Spitzer, W Velasquez, DD Weisenburger and J Fernandez-Ranada
Bone Marrow Transplant Department, Centre Leon Berard, Lyon, France.
Fifty patients with intermediate- or high-grade non-Hodgkin's lymphoma
(NHL) who had relapsed after a complete remission induced by an
Adriamycin-containing chemotherapy regimen participated in this prospective
pilot study. The patients ranged in age from 16 to 60 years (median 42
years). All patients received dexamethasone, high-dose cytarabine, and
cisplatin (DHAP) for two courses at 3- to 4-week intervals. Patients
achieving a partial or complete response were scheduled to receive
involved-field radiotherapy and high-dose carmustine, etoposide,
cytarabine, and cyclophosphamide (BEAC), followed by autologous bone marrow
transplantation (ABMT). Among 48 evaluable patients (ie, 1 was lost to
follow-up and 1 had no measurable disease) 7 patients obtained a complete
response (CR) and another 21 patients achieved partial response (PR),
whereas the remaining 20 patients failed. One responder died of
treatment-related toxicity, and six others declined ABMT. The patient with
no measurable disease did not progress on DHAP and was submitted to ABMT.
Twenty-two patients underwent ABMT [20 with BEAC and 2 with
cyclophosphamide plus total body irradiation (TBI)] of whom 2 (9%) died of
toxicity and 10 relapsed. One patient was a suicide at 28 months post-ABMT
in CCR and 9 are alive disease-free 24 months to 32 months (median 30
months) post- ABMT. The actuarial 2-year event-free survival for patients
undergoing transplantation is 40%. This prospective multicenter trial
documents the ability of DHAP followed by ABMT to produce durable complete
remission in a significant proportion of patients with relapsed aggressive
NHL. Forty-four percent of all patients with relapsed lymphoma who entered
the study actually underwent ABMT and 20% of the total group are projected
to be long-term disease-free survivors.
Volume 77,
Issue 7,
pp. 1587-1592,
04/01/1991
Copyright © 1991 by The American Society of Hematology
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