A retrospective analysis of 144 patients with aggressive non-Hodgkin's lymphoma: impact of autologous stem cell transplantation in first remission on outcome.
OBJECTIVE
To analyze the impact of a sequential program including autologous stem cell transplantation in first remission on the outcome of patients with aggressive non-Hodgkin's lymphoma.


METHODS
Patients aged less than 60 years old, with an aggressive non-Hodgkin's lymphoma and at least a partial response after first line therapy (chemotherapy +/- radiotherapy) were included in the study.


RESULTS
One hundred and forty-four patients were registered: of them 126 reached at least a partial response after first line therapy and 71 ( 56.5%) were then submitted to autologous stem cell transplantation. The overall survival (OS) and progression-free survival (PFS) of the whole population were respectively 70% and 63% at a median follow-up from diagnosis of 51 months (7-115). The PFS of the transplanted group was 93% at a median follow-up from diagnosis of 54 months (20-155); the PFS of the non-transplanted patients was 43.5% at a median follow-up from diagnosis of 30 months (8-109) (p <0.0001).


CONCLUSIONS
The two groups (transplanted vs not transplanted patients in remission after induction therapy) were homogeneous concerning the major risk factors (stage III Eth IV Eth p = 0.26; performance status Eth p = 0.25; B-symptoms Eth p = 0. 3; LDH level Eth p = 0.4; extranodal disease Eth p=0.4; bulky disease Eth p = 0.7): so we compared them in order to discover clinical features at diagnosis adversely affected PFS. In a multivariate analysis, factors which adversely affected PFS were: LDH level Eth p = 0.03; number of extranodal sites Eth p = 0.04; not performing the transplant Eth p = 0.02. When patients were stratified by number of extranodal sites and by LDH level, only the transplant being performed retained its positive influence Eth p = 0.04.
Fanin
R
R
Division of Haematology, University Hospital, p.le S. Maria della Misericordia, 33100 Udine, Italy. renato.fanin@drmm.uniud.it
Sperotto
A
A
Ruiz De Elvira
C
C
Zaja
F
F
Stocchi
R
R
Geromin
A
A
Cerno
M
M
Patriarca
F
F
Fanni Canelles
M
M
Damiani
D
D
Baccarani
M
M
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use / Q000633:toxicity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome