Impact of high-dose chemotherapy and autologous transplantation as first-line therapy on the survival of high-risk diffuse large B cell lymphoma patients: a single-center study in Japan

• Published in: International journal of hematology Vol. 99; no. 2; pp. 162 - 168
• Main Authors: Inano, Shojiro, Iwasaki, Makoto, Iwamoto, Yoshihiro, Sueki, Yuki, Fukunaga, Akiko, Yanagita, Soshi, Arima, Nobuyoshi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.02.2014; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antibodies, Monoclonal, Murine-Derived - adverse effects; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cohort Studies; Combined Modality Therapy - adverse effects; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Hematology; Humans; Induction Chemotherapy - adverse effects; Japan; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - pathology; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Original Article; Peripheral Blood Stem Cell Transplantation - adverse effects; Prednisone - administration & dosage; Prednisone - adverse effects; Prednisone - therapeutic use; Retrospective Studies; Survival Analysis; Transplantation, Autologous - adverse effects; Vincristine - administration & dosage; Vincristine - adverse effects; Vincristine - therapeutic use; Asia; Japan; Autologous; Diffuse large B cell lymphoma; High-dose therapy; Upfront; High-risk; Human; High risk; Hematology; Stem cell; Hematopoietic cell; B cell neoplasm; Malignant hemopathy; Non Hodgkin lymphoma; Survival; First line treatment; Chemotherapy; Treatment; Lymphoproliferative syndrome; Autologous hematopoietic stem cell transplantation; High dose; Cancer
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-013-1486-6

High-dose chemotherapy (HDT), together with autologous stem cell transplantation (ASCT), plays an important role in the treatment of diffuse large B cell lymphoma (DLBCL), especially as second-line therapy. However, its significance in up-front settings remains to be elucidated. In our institute, patients with DLBCL in both the high-intermediate and high international prognostic index (IPI) groups initially underwent CHOP/R-CHOP treatment followed by HDT/ASCT at upfront settings between 2002 and 2011. We retrospectively analyzed 25 patients who were all treated with upfront HDT/ASCT. We excluded one patient who failed to undergo transplantation because of primary refractory disease from the analysis. The median follow-up was 77 months (range 17–110 months). Five-year overall survival (OS) and progression-free survival (PFS) were 91.7 and 79.2 %, respectively, which were higher than the equivalents in previous studies. The OS and PFS in the high-risk group were lower than those in the high-intermediate group. Treatment-related mortalities or fatal complication were not observed. Our results confirm that HDT/ASCT for high-risk aggressive lymphoma is a feasible and promising therapy, but patients with high IPI continued to have poor prognoses; improvements in treatment strategy are clearly needed. Since HDT/ASCT is an aggressive treatment option associated with long-term complications, we need to identify patient groups that will gain the maximum benefit from HDT/ASCT in the upfront setting.