title: High-dose therapy in diffuse large cell lymphoma: results and prognostic factors in 452 patients from the GEL-TAMO Spanish Cooperative Group.
abstract: BACKGROUND
  The purpose of this study was to analyse the results and prognostic factors influencing overall survival (OS) and disease-free survival (DFS) in 452 patients diagnosed with diffuse large cell lymphomas (DLCL) treated with high-dose therapy (HDT) included in the Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL-TAMO) Spanish registry.
  
  
  METHODS
  At transplantation, median age was 42 years (range 15-73), 146 patients (32%) were transplanted in first complete remission (1st CR), 19% in second CR (2nd CR) and 47% had active disease: sensitive disease in 157 (35%) patients [95 were in first partial remission (1st PR) and 62 in second PR (2nd PR)] and refractory disease in 55 (12%) patients. Age-adjusted International Prognostic Index (IPI) was 2 or 3 in 51 patients (12%). Conditioning regimen consisted of BEAM (carmustine, etoposide, cytarabine and melphalan) in 39% of patients, BEAC (carmustine, etoposide, cytarabine and cyclophosphamide) in 33%, CBV (carmustine, etoposide and cyclophosphamide) in 10% and cyclophosphamide plus total body irradiation (TBI) in 12%.
  
  
  RESULTS
  Estimated overall survival (OS) and disease-free survival (DFS) at 5 years were 53% and 43%, respectively. The transplant-related mortality was 11% (53 cases). By multivariate analysis three variables significantly influenced OS and DFS: number of protocols to reach 1st CR, disease status at transplant and TBI in the conditioning regimen. Age-adjusted IPI at transplantation also influenced OS.
  
  
  CONCLUSIONS
  Prolonged OS and DFS can be achieved in patients with DLCL after HDT and our results suggest that the best line of chemotherapy should be used up-front in patients considered as candidates for HDT in order to obtain an early CR. Resistant patients are not good candidates for HDT and they should be offered newer strategies. Finally, polichemotherapy conditioning regimens offer better results compared with TBI.
authors.affiliation: Hospital Clínico Universitario, Salamanca, Spain. cabarri@usal.es
authors.forename: M D
authors.initials: MD
authors.lastname: Caballero
authors.forename: J A
authors.initials: JA
authors.lastname: Pérez-Simón
authors.forename: A
authors.initials: A
authors.lastname: Iriondo
authors.forename: J J
authors.initials: JJ
authors.lastname: Lahuerta
authors.forename: J
authors.initials: J
authors.lastname: Sierra
authors.forename: J
authors.initials: J
authors.lastname: Marín
authors.forename: M
authors.initials: M
authors.lastname: Gandarillas
authors.forename: R
authors.initials: R
authors.lastname: Arranz
authors.forename: J
authors.initials: J
authors.lastname: Zuazu
authors.forename: V
authors.initials: V
authors.lastname: Rubio
authors.forename: A
authors.initials: A
authors.lastname: Fernández de Sevilla
authors.forename: E
authors.initials: E
authors.lastname: Carreras
authors.forename: J
authors.initials: J
authors.lastname: García-Conde
authors.forename: J
authors.initials: J
authors.lastname: García-Laraña
authors.forename: C
authors.initials: C
authors.lastname: Grande
authors.forename: A
authors.initials: A
authors.lastname: Sureda
authors.forename: M J
authors.initials: MJ
authors.lastname: Vidal
authors.forename: J
authors.initials: J
authors.lastname: Rifón
authors.forename: C
authors.initials: C
authors.lastname: Pérez-Equiza
authors.forename: R
authors.initials: R
authors.lastname: Varela
authors.forename: J M
authors.initials: JM
authors.lastname: Moraleda
authors.forename: J C
authors.initials: JC
authors.lastname: García Ruíz
authors.forename: C
authors.initials: C
authors.lastname: Albó
authors.forename: R
authors.initials: R
authors.lastname: Cabrera
authors.forename: J F
authors.initials: JF
authors.lastname: San Miguel
authors.forename: E
authors.initials: E
authors.lastname: Conde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D014408:Biomarkers, Tumor / Q000032:analysis*; D002330:Carmustine; D003131:Combined Modality Therapy; D003520:Cyclophosphamide; D003561:Cytarabine; D016207:Cytokines; D004317:Doxorubicin; D005047:Etoposide; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D008558:Melphalan; D008875:Middle Aged; D011034:Podophyllotoxin; D011241:Prednisone; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine
chemical_list: D014408:Biomarkers, Tumor; D016207:Cytokines; D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone