Blood Res.  2014 Jun;49(2):107-114. 10.5045/br.2014.49.2.107.

R-CHOP chemoimmunotherapy followed by autologous transplantation for the treatment of diffuse large B-cell lymphoma

• Lee HG
• Choi Y
• Kim SY
• Kim I
• Kim YK
• Kim YS
• Lee HS
• Kim SJ
• Kim JA
• Park BB
• Park J
• Shim H
• Eom HS
• Lee J
• Park SK
• Cheong JW
• Park KW

• KMID: 2172806
• DOI: http://doi.org/10.5045/br.2014.49.2.107

Abstract

BACKGROUND
We investigated factors that influence outcomes in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab combined with the CHOP regimen (R-CHOP) followed by upfront autologous stem cell transplantation (Auto-SCT).
METHODS
We retrospectively evaluated survival differences between subgroups based on the age-adjusted International Prognostic Index (aaIPI) and revised-IPI (R-IPI) at diagnosis, disease status, and positron emission tomographic/computerized tomographic (PET/CT) status at transplantation in 51 CD20-positive DLBCL patients treated with R-CHOP followed by upfront Auto-SCT.
RESULTS
Patients had either stage I/II bulky disease (5.9%) or stage III/IV disease (94.1%). The median patient age at diagnosis was 47 years (range, 22-66 years); 53.3% and 26.7% had high-intermediate and high risks according to aaIPI, respectively. At the time of Auto-SCT, 72.5% and 27.5% experienced complete (CR) and partial remission (PR) after R-CHOP, respectively. The median time from diagnosis to Auto-SCT was 7.27 months (range, 3.4-13.4 months). The 5-year overall (OS) and progression-free survival (PFS) were 77.3% and 72.4%, respectively. The 5-year OS and PFS rates according to aaIPI, R-IPI, and PET/CT status did not differ between the subgroups. More importantly, the 5-year OS and PFS rates of the patients who achieved PR at the time of Auto-SCT were not inferior to those of the patients who achieved CR (P=0.223 and 0.292, respectively).
CONCLUSION
Survival was not influenced by the aaIPI and R-IPI at diagnosis, disease status, or PET/CT status at transplantation, suggesting that upfront Auto-SCT might overcome unfavorable outcomes attributed to PR after induction chemoimmunotherapy.

Keyword

Diffuse large B-cell lymphoma; Hematopoietic stem cell transplantation; Autologous transplantation; Rituximab; Survival analysis

MeSH Terms

Autografts*
Diagnosis
Disease-Free Survival
Electrons
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma, B-Cell*
Positron-Emission Tomography and Computed Tomography
Retrospective Studies
Stem Cell Transplantation
Survival Analysis
Transplantation, Autologous*
Rituximab

Figure

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  Fig. 1 (A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) for 51 diffuse large B-cell lymphoma (DLBCL) patients. (B) Probability of progression-free survival after Auto-SCT for 51 DLBCL patients.

• 

  Fig. 2 (A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the age-adjusted International Prognostic Index (aaIPI) score at diagnosis. (B) Probability of progression-free survival after Auto-SCT according to the aaIPI score at diagnosis.

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  Fig. 3 (A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the revised International Prognostic Index (IPI) score at diagnosis. (B) Probability of progression-free survival after Auto-SCT according to the revised IPI score at diagnosis.

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  Fig. 4 (A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the disease status at transplantation. (B) Probability of progression-free survival after Auto-SCT according to the disease status at transplantation.

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  Fig. 5 (A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the disease status at transplantation for patients classified into the age-adjusted International Prognostic Index (aaIPI) high-intermediate- and high-risk groups. (B) Probability of progression-free survival after Auto-SCT according to the disease status after transplantation for patients classified into the aaIPI high-intermediate and high-risk groups.

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  Fig. 6 (A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the 18F-fluoro-2-deoxy-D-glucose positron emission tomographic/computed tomographic (FDG PET/CT) status at transplantation. (B) Probability of progression-free survival after Auto-SCT according to the FDG PET/CT status at transplantation.

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