Role of frontline autologous stem cell transplantation in young, high-risk diffuse large B-cell lymphoma patients.
10.3904/kjim.2015.30.3.362
- Author:
Jae Ho YOON
1
;
Jong Wook KIM
;
Young Woo JEON
;
Sung Eun LEE
;
Ki Seong EOM
;
Yoo Jin KIM
;
Seok LEE
;
Hee Je KIM
;
Chang Ki MIN
;
Jong Wook LEE
;
Woo Sung MIN
;
Chong Won PARK
;
Seok Goo CHO
Author Information
1. Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. chosg@catholic.ac.kr
- Publication Type:Original Article ; Clinical Study ; Comparative Study ; Research Support, Non-U.S. Gov't
- Keywords:
Lymphoma;
Lymphoma, large B-cell, diffuse;
Autologous hematopoietic cell transplantation
- MeSH:
Adolescent;
Adult;
Age Factors;
Antibodies, Monoclonal, Murine-Derived/therapeutic use;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use;
Biomarkers, Tumor/blood;
Chemotherapy, Adjuvant;
Cyclophosphamide/therapeutic use;
Disease Progression;
Disease-Free Survival;
Doxorubicin/therapeutic use;
Female;
Humans;
Kaplan-Meier Estimate;
L-Lactate Dehydrogenase/blood;
Lymphoma, Large B-Cell, Diffuse/blood/mortality/pathology/*surgery;
Male;
Middle Aged;
Neoadjuvant Therapy;
Neoplasm Staging;
Predictive Value of Tests;
Prednisone/therapeutic use;
Proportional Hazards Models;
Reproducibility of Results;
Risk Assessment;
Risk Factors;
*Stem Cell Transplantation;
Time Factors;
Transplantation, Autologous;
Treatment Outcome;
Up-Regulation;
Vincristine/therapeutic use;
Young Adult
- From:The Korean Journal of Internal Medicine
2015;30(3):362-371
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto-HSCT. METHODS: We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score > or = 2. From 2006 to 2011, among the 150 DLBCL patients aged < or = 60 years who were treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), 23 high-risk patients with a complete response (CR) were treated with auto-HSCT. For comparison, we selected 35 well-matched high-risk patients with CR who completed R-CHOP treatment alone. In addition, there were 81 low-risk patients and 11 refractory patients. RESULTS: DLBCL patients with an aaIPI score > or = 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone. CONCLUSIONS: We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level.
