Induction chemotherapy followed by up-front autologous stem cell transplantation may have a survival benefit in high-risk diffuse large B-cell lymphoma patients.
We compared the outcomes of patients with higher-risk diffuse large B-cell lymphoma (DLBCL) who were treated with either up-front autologous stem cell transplantation (ASCT) or salvage chemotherapy followed by delayed ASCT after relapse. Data for 122 DLBCL patients who underwent ASCT as up-front or salvage treatment were analyzed. The 3-year overall survival (OS) rate in DLBCL patients who underwent up-front ASCT was 76.6%, and the rate for those who underwent delayed ASCT was 60.9% (p = 0.017). In a subgroup analysis of patients with a high-intermediate/high-risk age-adjusted International Prognostic Index, achievement of complete remission translated into improved OS in the up-front ASCT group, whereas patients who achieved partial remission had similar OS rates in both groups. The up-front ASCT group had improved OS in patients aged <50 years or with good performance status, whereas the OS rates of both groups were similar in patients aged ≥ 60 years or with poor performance status. When the OS outcome is analyzed by the number of factors (no complete remission during R-CHOP induction chemotherapy, age ≥ 50 years, and performance status ≥ 2), the 3-year OS rates of patients with zero or one, two, and three clinical factors were 80.2%, 51.6%, and 0%, respectively (p < 0.001). In conclusion, in higher-risk DLBCL patients, induction chemotherapy followed by up-front ASCT may have a survival benefit compared with induction chemotherapy alone in highly selected patients who have achieved a complete remission, who are aged <50 years, and who have a good performance status at diagnosis.
Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Ho-Jin
HJ
Shin
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Dok Hyun
DH
Yoon
Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Ho Sup
HS
Lee
Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
Sung Yong
SY
Oh
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Gwangju, Korea.
Deok Hwan
DH
Yang
Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Hye Jin
HJ
Kang
Department of Internal Medicine, Bundang Cha Hospital, Seongnam, Korea.
So Young
SY
Chong
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Yong
Y
Park
Department of Hematology and Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
YoungRok
Y
Do
Department of Internal Medicine, Haeundae Baek Hospital, Busan, Korea.
Sung-Nam
SN
Lim
Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea.
Jae-Cheol
JC
Jo
Department of Hematology and Oncology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
Won Sik
WS
Lee
Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea. Electronic address: hemon@pusan.ac.kr.
Joo-Seop
JS
Chung
D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D012189:Retrospective Studies; D000069283:Rituximab; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone