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Background: Randomized controlled trials (RCTs) reported conflicting results on the impact of high-dose chemotherapy (HDCT) and autologous stem cell transplantation in the first-tine treatment of patients with aggressive non-Hodgkin lymphoma (NHL). Methods: We performed a systematic meta-analysis to assess the efficacy HDCT compared to conventional chemotherapy in aggressive NHL patients with regard to complete response (CR), overall survival (OS), event-free survival (EFS), toxicity, and impact of the age-adjusted International Prognostic Index (aalPI) risk factors. We searched the Cochrane Library, MEDLINE and other databases (1 / 1990 to 1 /2005). Hazard ratio (HR), relative risks (RR) and 95% confidence intervals (Cis) were calculated using the fixed effect model. Results: Fifteen RCTs including 2728 patients were identified. HDCT improved CR when compared to conventional chemotherapy (RR 1.11, CI 1.04-1.18). Overall, there was no evidence for HDCT to improve OS (HR 1.05, 95% CI 0.92-1.19) or EFS (HR 0.92, 95% CI 0.80-1.05) when compared with conventional chemotherapy. However, subgroup analysis indicated OS differences (p = 0.032) between good (HR 1.46, 95% CI 1.02-2.09) and poor risk (HR 0.95, 95% CI 0.81-1.11) patients. Conflicting results were reported for poor risk patients, where some studies reported improved and others reduced OS and EFS after HDCT. Conclusion: There was no evidence that HDCT improved OS and EFS in good risk NHL patients. The evidence for poor risk patients is inconclusive. HDCT should not be further investigated in good risk patients with aggressive NHL but high quality studies in poor risk patients are warranted. (C) 2007 Elsevier Ltd. All rights reserved.

Summary Thirty-six successive adult patients with lymphoblastic lymphoma entered a study of sequential chemotherapy consisting of an intensive LSA2-L2-type protocol to induce first complete remission. Eighteen patients in first CR (median age 22 years, range 15–51), underwent autologous bone marrow transplantation after receiving a conditioning regimen consisting of cyclophosphamide and total body irradiation. Of these 18 patients, 2 were in stage III and 16 in stage IV; 15 showed mediastinal and 9 bone marrow involvement at diagnosis. The transplant procedure was well tolerated and no treatment-induced deaths occurred. At this time, 14 out of 18 patients are alive and well between 1 and 60 months post transplant (median follow-up time 46 months) with an actuarial disease-free survival of 74%. This phase II study suggests that high-dose chemo-radiotherapy followed by autologous bone marrow transplantation may improve long-term disease-free survival in advanced stage adult lymphoblastic lymphoma.

Dentro das perspectivas futuras do tratamento dos linfomas não Hodgkin (LMH) está aquela de melhorar os resultados com os denominados linfomas de baixo grau de malignidade. Dentro do estado-da-arte atual, este grupo de linfomas pode ser considerado incurável. Desde o observar-e-esperar até o transplante alogênico de medula óssea, muitas dúvidas existem e devem ser esclarecidas. O objetivo desta revisão é de apresentar e discutir a utilização da Fludarabina , isolada ou associada à antraciclínicos e alquilantes no tratamento dos linfomas não Hodgkin de baixo grau de malignidade (LBG).

Alpha interferon has shown initial promise in the treatment of low-grade non-Hodgkin's lymphoma (NHL), especially with the nodular form of the disease. The present study enrolled 70 NHL patients who received either chlorambucil (CB; 10 mg/day) or CB plus interferon alfa-2b (5 million units (MU)/m2 subcutaneously three times a week). Among 63 evaluable patients, similar response rates (62.1% and 64.7% respectively) were recorded for the treatment arms. In patients receiving no maintenance therapy, those who received interferon alfa-2b during the induction phase showed a favourable trend in terms of incidence of relapse compared to those who had received chlorambucil alone. During maintenance therapy with interferon alfa-2b, no significant differences in the occurrence of relapse have yet been seen compared to patients on no maintenance therapy. A longer observation period is needed to make a definitive conclusion about the usefulness of interferon maintenance therapy and to evaluate further the effects of the combined schedule of chlorambucil and interferon induction on the duration of remission.

A group of 13 patients with advanced, diffuse Hodgkin's disease, poorly responding to the most widely employed primary chemotherapy regimens, were treated with massive chemotherapy (MCH) followed by rescue with non-frozen autologous bone marrow infusion (ABMT). Complete remission (CR) was obtained in 8 13 patients (61.5%) and partial remission in two. Hematopoietic recovery occurred in 12 cases. These preliminary results would seem to indicate that MCH with non-frozen ABMT may be successfully used in patients with resistant or relapsed Hodgkin's disease.

Thirty-one unselected patients with untreated acute non lymphoblastic leukemia (ANLL) ranging in age from 15 to 76 years received two courses of a new high-dose induction regimen consisting of idarubicin, etoposide and cytarabine. Patients who entered complete remission (CR) were then allocated to post-remission intensification (PRI). Patients under 40 years of age with a HLA-compatible donor were given bone marrow transplantation (BMT); those without an HLA identical donor received either autologous BMT (ABMT) or no subsequent therapy. Twenty-five out of 31 patients (80.6%) achieved CR (93.3% in young and 68.7% in old patients) and 14 (56%) after the first cycle. Six patients (five out six greater than 40 years) died of cerebral hemorrhage and/or infection during the induction phase and four additional patients (three elderly) died on the PRI for the same cause without recurrent disease. Eleven out 25 patients are disease-free survivors 2-34 months (median 10 months) after achievement of CR. In conclusion, this intensive chemotherapy regimen is effective both in young and older patients but the post-remission intensification is too aggressive in elderly patients.

Cells obtained from 120 cases of acute and chronic leukaemias (both non-lymphocytic, ANL, and lymphoid leukaemias, ALL) were reacted in an indirect immunofluorescence test with antilymphocytic globulins (ALG) directed against different lymphoid cell populations (spleen, lymph node, tonsil, thymus, thoracic duct, peripheral blood lymphocytes, chronic lymphatic leukaemias cells and cultured lymphoblasts). The aim of this study was to recognize lymphoid antigens expressed on both thymus and bone marrow derived lymphocytes, as well as on leukaemic cells. Our 4 years' experience can be summarized as follows: (1) unabsorbed ALGs strongly react with B, T cells, as well as with all leukaemic cells tested; (2) myeloid cross-reactivity can be overcome after proper absorptions with cells from AML or AMoL or CML or with neutrophils from healthy donors; (4) MY-absorbed ALG can still interact with B, T lymphocytes, CLL-cells, blasts from B, T, null ALL and cells from CML in lymphoid blastic crisis, but not with myeloid or monocytic cells; (5) four out of five undifferentiated leukaemias proved to be reactive to ALG, as well as four out of 31 AML. All ALG-positive cases (LY+ cases), irrespective of their cytochemical diagnosis, were treated with vincristine-prednisone, with good response rates. The biological and clinical significance of these results are discussed.