Autologous transplantation for diffuse aggressive non-Hodgkin lymphoma in first relapse or second remission.
We evaluated the results of high-dose chemotherapy and autologous hematopoietic stem cell transplantation in patients with diffuse aggressive non-Hodgkin lymphoma (NHL) in first relapse (Rel 1) or second complete remission (CR 2). Data were evaluated from the Autologous Blood and Marrow Transplant Registry on 429 patients with diffuse aggressive NHL who underwent transplantation in Rel 1 or CR 2. Transplantations were performed between 1989 and 1996 and were reported to the Autologous Blood and Marrow Transplant Registry by 93 centers in North and South America. The probability of 3-year survival was 44% (95% confidence interval [CI], 33%-55%). The probability at 3 years of progression-free survival was 31% (95% CI, 27%-36%). Patients who underwent transplantation in CR 2 had a 3-year probability of progression-free survival of 38% (95% CI, 30%-46%) compared with 28% (95% CI, 22%-33%) for those who were not in remission at the time of transplantation (P <.001). In multivariate analysis, chemotherapy resistance, increased lactic dehydrogenase at diagnosis, an interval of <12 months from diagnosis to relapse, age >or=40 years, and use of myeloid growth factors to accelerate posttransplantation bone marrow recovery were adverse predictors of survival. High-dose chemotherapy and autologous hematopoietic stem cell transplantation for patients with diffuse aggressive NHL in CR 2 or Rel 1 resulted in better outcome for patients with chemotherapy-sensitive disease, longer relapse-free intervals, and age <40 years. Exposure to myeloid growth factors to accelerate recovery for recipients of bone marrow grafts may increase the risk of disease progression or death.
Vose
Julie M
JM
University of Nebraska Medical Center, Omaha 68198-7680, USA. jmvose@unmc.edu
Rizzo
Douglas J
DJ
Tao-Wu
Jing
J
Armitage
James O
JO
Bashey
Asad
A
Burns
Linda J
LJ
Christiansen
Neal Paul
NP
Freytes
Cesar O
CO
Gale
Robert Peter
RP
Gibson
John
J
Giralt
Sergio A
SA
Herzig
Roger H
RH
Lemaistre
Charles F
CF
McCarthy
Philip L
PL
Nimer
Stephen D
SD
Petersen
Finn B
FB
Schenkein
David P
DP
Wiernik
Peter H
PH
Wiley
Joseph M
JM
Loberiza
Fausto R
FR
Lazarus
Hillard M
HM
van Biesen
Koen
K
Horowitz
Mary M
MM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004796:Clinical Enzyme Tests; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006133:Growth Substances / Q000009:adverse effects / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D006133:Growth Substances