Primary mediastinal large cell lymphoma (PMBL): frontline treatment with autologous stem cell transplantation (ASCT). The GEL-TAMO experience.
Given the excellent results obtained with present new induction regimens in PMBL, the role of frontline ASCT is controversial. We present 71 patients with PMBL receiving induction chemotherapy, followed by ASCT as frontline therapy from the GEL-TAMO registry. Most patients presented with high-risk clinical features. At transplant, 49% of patients were in CR, 32% in PR and 18% failed induction therapy; 53% received radiotherapy. After the transplant 75% of patients achieved CR. With a median follow-up of 52.5 months, the OS, PFS and DFS at 4 years from diagnosis were, respectively, 84%, 81% and 81% for the first CR patients and 49%, 42% and 82% for the induction failure (PR and refractory) patients. Disease progression was the main cause of death (79%). By multivariate survival analysis the tumour score, refractory disease at transplant and radiotherapy were independent variables associated with OS and PFS. Our experience, with a prolonged follow-up, shows that patients with PMBL presenting at diagnosis with high-risk features or PR response to induction therapy have an encouraging survival with frontline ASCT. However, patients who received the transplant after failing the induction regimen have a very poor prognosis and should be tested with other innovative approaches. Finally, only a randomized trial could prove the value of ASCT as frontline therapy and also must be considered that addition to Rituximab to induction treatments could make ASCT unnecessary.
Rodríguez
José
J
Service of Hematology and Oncology Department, University Hospital Son Dureta, Palma de Mallorca, Balearic Islands, Spain. jrodriguez@hsd.es
Conde
Eulogio
E
Gutiérrez
Antonio
A
García
Juan Carlos
JC
Lahuerta
Juan José
JJ
Varela
María Rosario
MR
Pérez
Catalina
C
Albo
Carmen
C
Caballero
María Dolores
MD
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000628:therapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012042:Registries; D014182:Transplantation, Autologous