title: [Dose-intensive immunochemotherapy with or without autologous hematopoietic stem cell transplantation in the treatment of 29 newly diagnosed young patients with medium/high risk diffuse large B-cell lymphoma].
abstract: OBJECTIVE
  To assess the efficacy of dose-intensive immunochemotherapy with or without autologous hematopoietic stem cell transplantation (ASCT) for newly diagnosed young patients with medium/high risk diffuse large B-cell lymphoma (DLBCL).
  
  
  METHODS
  The retrospective study was performed in 29 cases of young patients (≤ 60 years) with newly diagnosed DLBCL and an age-adjusted International Prognostic Index (aaIPI) score of 2 or 3. All of them were treated with dose-intensive regimens (DA-EPOCH or Hyper-CVAD/MA) combined with Rituximab and some were consolidated with first-line ASCT. The efficacy and the potential predictors were evaluated.
  
  
  RESULTS
  The median age of 29 patients was 43 years old. Of them, 12 patients were consolidated with high-dose chemotherapy and ASCT. The complete remission (CR) rate was 69%, the partial remission (PR) rate 21% and the overall response rate 90%. After a median follow-up of 14 months, the estimated progression-free survival (PFS) and overall survival (OS) at two years were 64% and 70%, respectively. The median PFS and OS were significantly longer in CR patients than that in PR patients (P=0.015 and 0.061, respectively). Two patients achieved PR after induction therapy converted to CR after ASCT and were in continuous CR after follow-up above three years. In multivariate analysis, only bone marrow involvement (BMI) at diagnosis had an adverse influence in PFS (P=0.009), but not in OS. Based on whether there was BMI or not and the extent of BMI at diagnosis, the patients were divided into three groups as BM-0 (without BMI), BM-1 (the extent of BMI ≤ 10%) and BM-2 (the extent of BMI>10%). Patients in BM-2 group had significantly shorter PFS and OS than those in BM-0 and BM-1 groups (P=0.001 and 0.045, respectively). In multivariate analysis, the extent of BMI>10% was the independent poor prognostic factor for PFS and CNS relapse or prognosis.
  
  
  CONCLUSIONS
  Dose-intensive immunochemotherapy followed by ASCT or not has significant effect on efficacy of first-line treatment for young and untreated patients with medium/high risk DLBCL. The extent of BMI>10% at diagnosis is an independent risk factor associated with poor PFS and increased CNS relapse or progression.
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Shuhua
authors.initials: S
authors.lastname: Yi
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Lyu
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Zengjun
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Sui
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Wenyang
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Tingyu
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Shuhui
authors.initials: S
authors.lastname: Deng
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Mingwei
authors.initials: M
authors.lastname: Fu
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Dehui
authors.initials: D
authors.lastname: Zou
authors.affiliation: Department of Lymphoma and Myeloma, Institute of Hematology & Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
authors.forename: Lugui
authors.initials: L
authors.lastname: Qiu
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab