Pretransplantation Positron Emission Tomography Scan Is the Main Predictor of Autologous Stem Cell Transplantation Outcome in Aggressive B-Cell Non-Hodgkin Lymphoma

BACKGROUND. Limited data exist about the role of second-line chemotherapy response assessed by positron emission tomography (PET) as a prognostic factor in patients with aggressive non-Hodgkin Lymphoma (NHL) who undergo autologous stein cell transplantation (ASCT). The objective of this analysis was to investigate the main determinants of prognosis in patients with aggressive B-cell NHL who undergo ASCT, focusing Oil the impact of pretransplantation PET, secondary, age-adjusted International Prognostic Index (sAA-IPI) score, histology, and previous response to first-line chemotherapy. METHODS. Seventy-five patients with diffuse, large B-cell lymphoma or grade 3 follicular lymphoma who were treated at the author institution with second-line chemotheraphy (combined ifosfamide, etoposide, and epirubicin [IEV]) followed by ASCT between September 2002 and September 2006 were included. All patients were evaluated by PET after I to 3 Courses of IEV chemotherapy before ASCT, and all patients received a conditioning regimen of combined carmustine, etoposide, cytosine arabinoside, and melphalan. The prognostic impact of pre-transplantation PET sAA-IPI score, histology, and previous response to First-line chemotherapy was evaluated by univariate and multivariate analyses. RESULTS. Seventy-two of 75 patients underwent ASCT. In a univariate analysis for progression-free survival (PES) and overall survival (OS), a significant association was observed with pretransplantation PET (PFS, P < .00001; OS, P < .01) and previous first-line response (PFS, P = .02; OS, P = .04). In the multivariate framework, pretransplantation PET was identified as the only independent prognostic factor (PFS, P < .001; OS, P = .01). CONCLUSIONS. The current data indicated that pretransplantation PET is the main prognostic predictor in patients with aggressive B-cell NHL who are scheduled For ASCT. Cancer 2008;113:2496-503. (C) 2008 American Cancer Society.