Autologous stem-cell transplantation in diffuse large B-cell non-Hodgkin's lymphoma not achieving complete response after induction chemotherapy: the GEL/TAMO experience
Rodriguez J, Caballero MD, Gutierrez A, Solano C, Arranz R, Lahuerta JJ, Sierra J, Gandarillas M, Perez-Simon JA, Zuazu J, Lopez-Guillermo A, Sureda A, Carreras E, Garcia-Laraña J, Marin J, Garcia JC, Fernandez De Sevilla A, Rifon J, Varela R, Jarque I, Albo C, Leon A, SanMiguel J, Conde E.
Hospital Son Dureta, Palma de Mallorca, Spain
Here we evaluate the results of high-dose chemotherapy and autologous stem-cell transplantation (HDC/ASCT) in 114 patients included in the GEL/TAMO registry between January 1990 and December 1999 with diffuse large B-cell lymphoma who failed to achieve complete remission (CR) with front-line conventional chemotherapy.
PATIENTS AND METHODS
Sixty-eight per cent had a partial response (PR) and 32% failed to respond to front-line therapy. At transplant, 35% were chemoresistant and 29% had two to three adjusted International Prognostic Index (a-IPI) risk factors.
After HDC/ASCT, 57 (54%) of 105 patients evaluable for response achieved a CR, 16 (15%) a PR and 32 (30%) failed. Nine patients were not assessed for response because of early death due to toxicity. With a median follow-up of 29 months for alive patients, the survival at 5 years is 43%, with a disease-free survival for complete responders of 63%. The lethal toxicity was 8%. Multivariate analysis revealed a-IPI and chemoresistance to be predicting factors.
Our results show that one-third of patients who do not obtain a CR to front-line chemotherapy may be cured of their disease with HDC/ASCT. However, most chemoresistant patients pretransplant failed this therapy. For this population, as well as for those who presented with adverse factors of the a-IPI, pretransplant novel therapeutic modalities need to be tested.
CITATION Ann Oncol. 2004 Oct;15(10):1504-9