Long-term follow-up of patients with diffuse large B-cell non-Hodgkin's lymphoma receiving purged autografts after induction failure

Abstract

Patients with diffuse large B-cell lymphoma (DLBCL) who do not achieve a complete response to front-line combination chemotherapy are often offered high-dose therapy and autologous hematopoietic cell transplantation (AHCT). However, the efficacy of this therapy in this patient population has been addressed in only a few published reports. We retrospectively analyzed the outcomes of patients with a diagnosis of de novo DLBCL who underwent AHCT at our center between 1988 and 2002, and identified 43 consecutive patients who had not achieved a CR before AHCT, although most showed at least a partial response (PR) to either induction or subsequent salvage chemotherapy. A total of 15 patients received a conditioning regimen that included high-dose chemotherapy with fractionated TBI (FTBI), whereas 28 patients received high-dose chemotherapy only. All autografts were treated ex vivo with MoAbs and complement in an effort to remove any residual malignant B cells. A total of 33 (77%) patients achieved a CR after AHCT. With a median follow-up of 7.3 years, the 5-year OS was 69% and EFS was 59%. Four patients died from non-relapse mortality. By univariate analyses, the following characteristics did not significantly impact OS: disease stage at diagnosis, age-adjusted IPI (International Prognostic Index) score, age X40 years, earlier radiotherapy and the use of FTBI in the conditioning regimen. These results confirm the long-term efficacy of AHCT for patients with DLBCL after induction failure.

Multiparameter analysis of homogeneously R-CHOP-treated diffuse large B cell lymphomas identifies CD5 and FOXP1 as relevant prognostic biomarkers: report of the prospective SAKK 38/07 study

“…As expected ([38] and literature therein), dynamic parameters, such as response to therapy and especially failure to achieve complete remission, which are not obtainable at diagnosis, seem to be the most reliable outcome indicators in DLBCL, yet expression of CD5 and FOXP1 added information independent of these disease dynamic parameters.…”

“…Within this prospective study, we identified potential biomarkers (expression of CD5 for EFS and expression of FOXP1 for OS) that were able to predict the course of DLBCL at diagnosis, independent of stage and IPI. As expected ([ 38 ] and literature therein), dynamic parameters, such as response to therapy and especially failure to achieve complete remission, which are not obtainable at diagnosis, seem to be the most reliable outcome indicators in DLBCL, yet expression of CD5 and FOXP1 added information independent of these disease dynamic parameters.…”