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Twenty Years of Autologous Stem Cell Transplantation in Diffuse Large B-Cell Lymphoma – a Single Center Experience
Background: Patients (pt) with advanced stage and high International Prognostic Index (IPI) or relapsed/primary refractory diffuse large B-cell lymphoma (DLBCL) have an adverse prognosis and are frequently consolidated with autologous stem cell transplantation (SCT).
Aim: Evaluation of a single center experience with SCT in DLBCL.
Methods: Retrospective analysis of outcome of adult pt submitted to SCT in DLBCL, between October 1992 and December 2012. Data were collected from the database and the medical records.
Results: 152 SCT were performed in various histological subtypes of DLBCL, during this time period. Statistical analysis was performed in 113 pt with "classical" DLBCL and histological variants were excluded.
Median age at SCT was 49 years (16-67), 68 males/45 females. At diagnosis the majority of pt were in advanced stage (85%) and had an IPI 2 or 3 (47%, 30% respectively). Considering the disease status at SCT and response to prior chemotherapy (CT) we divided the pt in the following groups: 1) 64 pt in 1st complete remission (CR) after 1 CT line, all with IPI≥2; 2) 15 pt in 1st CR after ≥2 CT lines; 3) 15 pt in 2nd CR; 4) 19 pt with more advanced diseased. Rituximab (R) was used with CT in 78 pt before SCT. The 1st line CT most frequently used was: R-CHOP: 71 pt (63%); CHOP: 28 pt (25%).
Conditioning regimen was: 93 pt BEAM and 20 pt FEAM. Hematopoietic stem cells were collected from: peripheral blood (PB) in 100, bone marrow (BM) in 2, and PB+BM in 11 pt.
The cause of death was: relapse/progression - 17 pt; non-relapsed mortality – 8 pt and secondary neoplasia 1pt.
The median follow up of alive pt was 34 months (1-221). Overall survival (OS) at 1, 3 and 5 years was 85%(±3); 75%(±4); 73%(±5). DFS at 1, 3 and 5 years was 84%(±4); 80%(±4); 75%(±5) respectively.
There were significant differences in OS between the 4 groups considered – table 2 (p<0.01).
| 1 year
| 3 years
| 5 years
|
Group 1
| 91%(±4)
| 86%(±5)
| 83%(±6)
|
Group 2
| 86%(±9)
| 86%(±9)
| 86%(±9)
|
Group 3
| 87%(±9)
| 73%(±12)
| 73%(±12)
|
Group 4
| 63%(±11)
| 46%(±12)
| 38%(±12)
|
In univariate analysis OS was significantly better if: early stage at diagnosis, less than 2 CT lines before SCT, disease status before SCT in CR, first line CT with R-CHOP, PB stem cells.
Conclusion: About 70 % of high-risk pt were free of disease after conventional CT followed by SCT. The outcome is influenced by disease status at SCT. Despite our results don't allow direct comparison of the impact of immunoCT with R, our pt in the R group had a better outcome. Most studies with SCT consolidation in these pt were performed in the pre-R era. There is as need to redefine the role of this treatment strategy nowadays. Further knowledge of prognosis factors is necessary, especially in young pt with high-risk disease at 1st CR, to determine whether the SCT still improves outcome.