title: LACE-conditioned autologous stem cell transplantation for relapsed or refractory diffuse large B-cell lymphoma: treatment outcome and risk factor analysis from a single centre.
abstract: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a recognized treatment option for patients with relapsed diffuse large B-cell lymphoma. We have analysed 51 patients who underwent ASCT after LACE (lomustine (CCNU), cytarabine (Ara-C), cyclophosphamide, etoposide) conditioning for relapsed (n = 34, 67%) or primary refractory (n = 17, 33%) diffuse large B-cell lymphoma. With a median follow-up of 60 months (range 2-216) the probabilities of overall survival (OS) and progression-free survival (PFS) at 5 years were 47 and 42%, respectively. The cumulative treatment-related mortality was 10% (n = 5). Probabilities for OS and PFS at 5 years were 56 and 50% for patients with chemosensitive and 29 and 27% for patients with chemorefractory disease. In multivariate analysis abnormal pre-ASCT levels of C-reactive protein (>5 mg/L) were identified as a risk factor for worse OS, whereas abnormal pre-ASCT levels of C-reactive protein and chemoresistance predicted inferior PFS. LACE followed by ASCT is an effective treatment for approximately half of patients with chemosensitive relapsed diffuse large B-cell lymphoma, and a proportion of chemorefractory patients also benefit.
authors.affiliation: Department of Haematology, Imperial College at Hammersmith Hospital, London, UK.
authors.forename: Jiří
authors.initials: J
authors.lastname: Pavlů
authors.forename: Holger W
authors.initials: HW
authors.lastname: Auner
authors.forename: Sarah
authors.initials: S
authors.lastname: Ellis
authors.forename: Richard M
authors.initials: RM
authors.lastname: Szydlo
authors.forename: Chrissy
authors.initials: C
authors.lastname: Giles
authors.forename: Alejandro
authors.initials: A
authors.lastname: Contento
authors.forename: Amin
authors.initials: A
authors.lastname: Rahemtulla
authors.forename: Jane F
authors.initials: JF
authors.lastname: Apperley
authors.forename: Kikkeri
authors.initials: K
authors.lastname: Naresh
authors.forename: Donald H
authors.initials: DH
authors.lastname: MacDonald
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Kanfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003967:Diarrhea / Q000209:etiology; D019008:Drug Resistance, Neoplasm; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage / Q000009:adverse effects; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013280:Stomatitis / Q000209:etiology; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D055815:Young Adult
chemical_list: D003561:Cytarabine; D005047:Etoposide; D008130:Lomustine; D003520:Cyclophosphamide