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KMID : 0366220140490020107
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Korean Journal of Hematology
2014 Volume.49 No. 2 p.107 ~ p.114
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R-CHOP chemoimmunotherapy followed by autologous transplantation for the treatment of diffuse large B-cell lymphoma
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Lee Hong-Ghi
Choi Yun-Suk
Kim Sung-Yong
Kim In-Ho
Kim Yeo-Kyeoung
Kim Yang-Soo
Lee Ho-Sup
Kim Seok-Jin
Kim Jeong-A
Park Byeong-Bae
Park Jin-Ny
Shim Hyeok
Eom Hyeon-Seok
Lee Jung-Lim
Park Sung-Kyu
Cheong June-Won
Park Keon-Woo
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Abstract
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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 fol-lowed by upfront Auto-SCT.
Results: Patients had either stage I/II bulky disease (5.9%) or stage III/IV disease (94.1%). The me-dian 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.
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KEYWORD
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Diffuse large B-cell lymphoma, Hematopoietic stem cell transplantation, Autologous transplantation, Rituximab, Survival analysis
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