High-dose etoposide could discriminate the benefit from autologous peripheral blood stem cell transplantation in the patients with refractory diffuse large B cell lymphoma

Yu Cai,Jieling Jiang,Juan Yang,Jun Zhu,Su Li,Liping Wan,Chun Wang,Xianmin Song

doi:10.1007/s00277-019-03605-1

Abstract

To evaluate the strategy of using high-dose etoposide mobilization followed by autologous peripheral blood stem cell transplantation (APBSCT) in patients with diffuse large B cell lymphoma (DLBCL) refractory to rituximab-based chemotherapy. Forty patients with refractory DLBCL were treated with high-dose etoposide for stem cell mobilization. All patients were in progressive disease (PD) prior to mobilization and underwent high-dose chemotherapy followed by APBSCT. Successful PBSC mobilization was achieved in all patients. Twenty-three patients (57.5%) showed a clinical response to high-dose etoposide. After APBSCT, 17 patients (42.5%) achieved CR. The 2-year progression-free (PFS) and overall survival (OS) rate were higher in patients responding to high-dose etoposide (64.1% and 77.7%) compared to those without response (11.8% and 11.8%; P < 0.001 for both). The response to high-dose etoposide mobilization therapy was an independent prognostic factor for CR achievement, PFS and OS after APBSCT. High-dose etoposide mobilization chemotherapy followed by APBSCT could rescue a proportion of patients with refractory DLBCL who responded to etoposide mobilization regimen.

Highlights

A significant proportion of patients with refractory diffuse large B cell lymphomas (DLBCL) fail to achieve CR or PR with conventional salvage therapy and never have a chance to proceed to transplantation, most often due to chemotherapyresistant diseases [1–3]
We evaluated the efficacy of highdose etoposide in stem cell mobilization followed by autologous peripheral blood stem cell transplantation (APBSCT) and identified a group of the patients with refractory lymphoma who benefitted from high-dose therapy (HDT)/APBSCT after responding clinically to high-dose etoposide mobilization chemotherapy
We report the outcome of refractory DBLCL after high-dose etoposide mobilization chemotherapy followed by APBSCT

Summary

Introduction

A significant proportion of patients with refractory diffuse large B cell lymphomas (DLBCL) fail to achieve CR or PR with conventional salvage therapy and never have a chance to proceed to transplantation, most often due to chemotherapyresistant diseases [1–3]. According to NCCN guideline, the subgroup of patients who have progression or resistance to chemotherapy should be considered for a clinical trial because they are not candidates for autologous peripheral blood stem cell transplantation (APBSCT) [4]. The results from the Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL-TAMO) and Autologous Blood and Marrow Transplant Registry (ABMTR) data suggest that high-dose therapy (HDT)/APBSCT can be considered for the patients who do not achieve CR but still remain sensitive to chemotherapy [10–14]. A proportion of the patients who are not sensitive to conventional salvage chemotherapy may still respond to highdose chemotherapy and could benefit from the use of HDT/APBSCT [15]. It remains unclear how to select the patients with refractory lymphoma who will have benefit from HDT/APBSCT

Methods

Results

Conclusion