Long-term follow-up after high-dose chemotherapy and autologous stem-cell transplantation for high-grade B-cell lymphoma suggests an improved outcome for high-risk patients with respect to the age-adjusted International Prognostic Index
Background: To evaluate the long-term benefit from high-dose chemotherapy (HDCT) with autologous stem-cell transplantation (ASCT), as part of the initial treatment for patients with chemosensitive, high-grade B non-Hodgkin's lymphoma (hg B-NHL), stratified according to the age-adjusted International Prognostic Index (aaIPI). Patients and methods: Eligible patients were 33 consecutive hg B-NHL patients responding to first-line chemotherapy and fulfilling at least one of the following criteria: stage III or IV, bulky disease, elevated lactate dehydrogenase or failure to achieve complete remission (CR). Twenty-two of 33 patients (67%) had two or three risk factors with respect to the aaIPI. All patients received HDCT with ASCT after a minimum of 6 weeks of VACOP-B standard therapy and VIP-E for mobilization. Results: After ASCT, 31 patients (94%) achieved CR. No treatment-related death occurred. The cumulative incidence of relapse at a medium follow-up of 10 years is 16% for 31 of 33 patients achieving CR. Twenty-five of 33 patients are in sustained CR with a disease-free survival of 76% [95% confidence interval (CI) 67% to 86%]. The overall survival at a median follow-up of 122 months (range 86-148) is 79% (95% Cl 68% to 89%). Conclusions: The results suggest that up-front HDCT with ASCT may improve long-term outcome in high-risk patients with chemotherapy-sensitive hg B-NHL when compared to historic populations treated solely with dose-intense chemotherapy. We observed that long-term survival of high-risk (two to three risk factors) patients is comparable to low-risk (zero to one risk factor) patients after HDCT and ASCT with a low incidence of late relapse.
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Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USAUniv Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Vose, JM
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Zhang, MJ
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Zhang, MJ
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Rowlings, PA
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Rowlings, PA
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Lazarus, HM
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Lazarus, HM
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Bolwell, BJ
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Bolwell, BJ
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Freytes, CO
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Freytes, CO
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Pavlovsky, S
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Pavlovsky, S
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Keating, A
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Keating, A
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Yanes, B
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Yanes, B
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van Besien, K
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van Besien, K
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Armitage, JO
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Armitage, JO
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Horowitz, MM
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
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Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USAUniv Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Vose, JM
;
Zhang, MJ
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h-index: 0
机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Zhang, MJ
;
Rowlings, PA
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Rowlings, PA
;
Lazarus, HM
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Lazarus, HM
;
Bolwell, BJ
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Bolwell, BJ
;
Freytes, CO
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Freytes, CO
;
Pavlovsky, S
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Pavlovsky, S
;
Keating, A
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Keating, A
;
Yanes, B
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Yanes, B
;
van Besien, K
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
van Besien, K
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Armitage, JO
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA
Armitage, JO
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Horowitz, MM
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机构:Univ Nebraska, Med Ctr, Dept Internal Med, Nebraska Med Ctr 987680, Omaha, NE 68198 USA