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

Abstract

BackgroundWe 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).MethodsWe 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.ResultsPatients 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).ConclusionSurvival 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.

The role of fluorine-18 fluorodeoxyglucose PET in prognosis evaluation for stem cell transplantation of lymphoma

“…DLBCL might be the most common histological subtype of NHL, corresponding to 30-40% of cases in adults [16,17,19]. MCL, like DLBCL, is an aggressive subtype of lymphoma, which, compared with distinct lymphoma, has diversified outcomes after a series of therapies.…”

“…HR, hazard ratio; OS, overall survival; PFS, progression-free survival; SCT, stem cell transplantation. Smeltzer et al [14] Mocikova et al [15] Devillier et al [16] Lee et al [17] Armand et al [18] Qiao et al [19] Derenzini et al [20] Hoppe et al [21] Qiao et al [22] Cremerius et al [23] Schot et al [24] Schot et al [26] Crocchiolo et al [28] Samaras et al [29] Note: Weights are from random effects analysis high-quality studies. Stars were then added up and used to compare the quality of the study quantitatively [9].…”

“…A total of 24 studies fulfilled the above requirement, whereas only 17 studies that included 1192 patients [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] were eligible for this study. Seven studies were excluded because they failed to present the HR/the exact OS/PFS curves (n = 4) or there were no pre-SCT or post-SCT PET scans (n = 3) in the studies.…”

The different roles of molecular classification according to upfront autologous stem cell transplantation in advanced-stage diffuse large B cell lymphoma patients with elevated serum lactate dehydrogenase

“…A randomized trial including patients treated with chemoimmunotherapy revealed that upfront ASCT improved progression-free survival (PFS) in aggressive NHL with a high-intermediate or high-risk IPI [11]. Recent studies reported that upfront ASCT improved OS in patients aged <50 years with good performance status at diagnosis in high-risk DLBCL and the unfavorable outcomes attributed to partial response (PR) after R-CHOP [12,13]. ASCT in first remission may provide survival benefits, as it removes minimally residual disease, and it may also have survival benefits for highly selected patients who have achieved CR [14].…”

Kinetics of hematogones in bone marrow samples from patients with non-Hodgkin lymphomas treated with rituximab-containing regimens: a flow cytometric study

“…Rituximab (chimeric anti-CD20 monoclonal antibody) is an important therapeutic tool, since NHLs are characterized by CD20 expression, and is used in combination with one or more antiblastic drugs [1][2][3][4][5][6] and for maintenance therapy after first-line chemo-immunotherapy [7].…”