title: Upfront autologous stem cell transplantation for untreated high-risk diffuse large B-cell lymphoma in patients up to 60 years of age.
abstract: BACKGROUND
  Although rituximab added to CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) is the standard chemotherapy for untreated DLBCL, its therapeutic effect is limited in younger patients with high-intermediate risk or high-risk disease according to the age-adjusted international prognostic index. In fact, the efficacy and safety of HDT plus rituximab followed by ASCT for such patients remain unclear.
  
  
  METHODS
  We retrospectively investigated the safety and effectiveness of HDT/ASCT in patients with untreated DLBCL. Twenty-two patients, aged 60 years and younger, with untreated DLBCL (classified as high-intermediate [n = 14 (64%)] or high [n = 8 (32%)] risk) underwent upfront HDT/ASCT between January 2004 and December 2008, achieving either a complete response (CR; n = 15 (68%)) or a partial response (PR; n = 7 (32%)).
  
  
  RESULTS
  The 5-year overall survival rate was 81.0% and the progression-free survival rate was 73.0%, with no significant difference between risk groups based on the international prognostic index. The most common nonhematologic toxicity was febrile neutropenia [n = 9 (41%)]. The cause of all 3 fatalities was exacerbation of the underlying disease, and no treatment-related mortality was observed. No variables with a significant influence on overall survival were identified, but a correlation of the treatment response before transplanation with progression-free survival was suggested (CR vs. PR: 92% vs. 30%, P = .002).
  
  
  CONCLUSIONS
  These results suggest that adding rituximab to upfront HDT/ASCT is feasible and can improve the outcome in untreated patients with poor-prognosis DLBCL. In the future, upfront HDT/ASCT should be more extensively evaluated in clinical trials.
authors.affiliation: Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan. takasakih@kcch.jp
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Takasaki
authors.forename: Chizuko
authors.initials: C
authors.lastname: Hashimoto
authors.forename: Atsuko
authors.initials: A
authors.lastname: Fujita
authors.forename: Kenji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Jun
authors.initials: J
authors.lastname: Taguchi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kuwabara
authors.forename: Etsuko
authors.initials: E
authors.lastname: Yamazaki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Koharazawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujita
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Ishii
authors.forename: Wataru
authors.initials: W
authors.lastname: Yamamoto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Motomura
authors.forename: Naoto
authors.initials: N
authors.lastname: Tomita
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
authors.forename: Rika
authors.initials: R
authors.lastname: Sakai
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D000069283:Rituximab; D016019:Survival Analysis; D014182:Transplantation, Autologous; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Autologous stem cell transplantation; Diffuse large B-cell lymphoma; MEAM