title: Autologous stem-cell transplantation in diffuse large B-cell non-Hodgkin's lymphoma not achieving complete response after induction chemotherapy: the GEL/TAMO experience.
abstract: BACKGROUND
  Here we evaluate the results of high-dose chemotherapy and autologous stem-cell transplantation (HDC/ASCT) in 114 patients included in the GEL/TAMO registry between January 1990 and December 1999 with diffuse large B-cell lymphoma who failed to achieve complete remission (CR) with front-line conventional chemotherapy.
  
  
  METHODS
  Sixty-eight per cent had a partial response (PR) and 32% failed to respond to front-line therapy. At transplant, 35% were chemoresistant and 29% had two to three adjusted International Prognostic Index (a-IPI) risk factors.
  
  
  RESULTS
  After HDC/ASCT, 57 (54%) of 105 patients evaluable for response achieved a CR, 16 (15%) a PR and 32 (30%) failed. Nine patients were not assessed for response because of early death due to toxicity. With a median follow-up of 29 months for alive patients, the survival at 5 years is 43%, with a disease-free survival for complete responders of 63%. The lethal toxicity was 8%. Multivariate analysis revealed a-IPI and chemoresistance to be predicting factors.
  
  
  CONCLUSIONS
  Our results show that one-third of patients who do not obtain a CR to front-line chemotherapy may be cured of their disease with HDC/ASCT. However, most chemoresistant patients pretransplant failed this therapy. For this population, as well as for those who presented with adverse factors of the a-IPI, pretransplant novel therapeutic modalities need to be tested.
authors.affiliation: Hospital Son Dureta, Palma de Mallorca, Spain. jrodriguez@hsd.es
authors.forename: J
authors.initials: J
authors.lastname: Rodriguez
authors.forename: M D
authors.initials: MD
authors.lastname: Caballero
authors.forename: A
authors.initials: A
authors.lastname: Gutierrez
authors.forename: C
authors.initials: C
authors.lastname: Solano
authors.forename: R
authors.initials: R
authors.lastname: Arranz
authors.forename: J J
authors.initials: JJ
authors.lastname: Lahuerta
authors.forename: J
authors.initials: J
authors.lastname: Sierra
authors.forename: M
authors.initials: M
authors.lastname: Gandarillas
authors.forename: J A
authors.initials: JA
authors.lastname: Perez-Simon
authors.forename: J
authors.initials: J
authors.lastname: Zuazu
authors.forename: A
authors.initials: A
authors.lastname: Lopez-Guillermo
authors.forename: A
authors.initials: A
authors.lastname: Sureda
authors.forename: E
authors.initials: E
authors.lastname: Carreras
authors.forename: J
authors.initials: J
authors.lastname: Garcia-Laraña
authors.forename: J
authors.initials: J
authors.lastname: Marin
authors.forename: J C
authors.initials: JC
authors.lastname: Garcia
authors.forename: A
authors.initials: A
authors.lastname: Fernandez De Sevilla
authors.forename: J
authors.initials: J
authors.lastname: Rifon
authors.forename: R
authors.initials: R
authors.lastname: Varela
authors.forename: I
authors.initials: I
authors.lastname: Jarque
authors.forename: C
authors.initials: C
authors.lastname: Albo
authors.forename: A
authors.initials: A
authors.lastname: Leon
authors.forename: J
authors.initials: J
authors.lastname: SanMiguel
authors.forename: E
authors.initials: E
authors.lastname: Conde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011379:Prognosis; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome