title: The non-relapse mortality rate for patients with diffuse large B-cell lymphoma is greater than relapse mortality 8 years after autologous stem cell transplantation and is significantly higher than mortality rates of population controls.
abstract: High dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the preferred treatment modality for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). To assess long-term outcomes of these patients, we retrospectively analysed data from 309 consecutive patients who underwent ASCT for DLBCL between 1994 and 2006. We found that non-relapse mortality (NRM) became the major cause of death beginning approximately 8 years after ASCT. The most common causes of NRM during the study period were respiratory failure (31%), infection (13%), cardiac toxicity (15%) and secondary malignancy (15%). The strongest predictor of relapse mortality (RM) was disease status at transplant: patients who were in second or greater complete or partial remission had a higher risk of RM than those in first complete or partial remission [hazard ratio (HR) 3·7, P<0·001], as did those who were relapsed or refractory (HR 4·9, P<0·001). We describe the longest reported follow-up of a large cohort of DLBCL patients uniformly-treated with ASCT. Although relapse was initially the more likely cause of death, NRM exceeded RM after 8 years. After ASCT, surviving patients have significantly increased risk mortality rates relative to the general population and this excess risk persists over time.
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA. hillb2@ccf.org
authors.forename: Brian T
authors.initials: BT
authors.lastname: Hill
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Stephen
authors.initials: S
authors.lastname: Smith
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.forename: Shawnda
authors.initials: S
authors.lastname: Tench
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Steven
authors.initials: S
authors.lastname: Andresen
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
authors.forename: John
authors.initials: J
authors.lastname: Sweetenham
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004812:Epidemiologic Methods; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult