P1-261 - Up-front high-dose chemotherapy followed by autologous stem cell transplantation for high-risk aggressive lymphoma

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Although the addition of Rituximab to chemotherapy has improved not only the response rate but also event-free survival of patients with diffuse large B-cell lymphoma (DLBCL), patients with high-risk DLBCL, including those with IPI high-intermediate (HI)-risk or high-risk diseases, those who are CD5 positive, and those with extranodal involvement, cannot attain sustained remission. Thus, new therapeutic strategies are needed for these patients. The present study retrospectively analyzed the effects of up-front high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) on eight high-risk DLBCL patients with one or more of these poor prognostic factors at our institute. Progression-free survival (PFS) was defined as the time from ASCT until disease progression or death. The median age of the patients was 46.5 years (range, 35 to 65 years). Five patients were IPI HI-risk or high-risk, two patients were CD5 positive, and all patients had extranodal disease. The median time from diagnosis to ASCT was 6.6 months (range, 2.2-17.9 months). Patients who achieved a complete response (CR) or partial response (PR) after two to five cycles of R-CHOP followed by one to two cycles of salvage chemotherapy were given high-dose chemotherapy with either the MCVAC regimen (ranimustine, cytarabine, etoposide, and cyclophosphamide) or the LEED regimen (melphalan, cyclophosphamide, etoposide, and dexamethasone). Before transplantation, five patients achieved a CR, and two patients achieved a PR. After transplantation, all patients had a CR. One patient experienced thrombotic microangiopathy, and complete recovery was achieved after plasma exchange. After a median follow-up time of 46 months (range, 15-77 months), the 2-year PFS was 100%. All patients were alive with a CR at the last follow-up. In summary, high-risk DLBCL was effectively treated with up-front high-dose chemotherapy followed by ASCT with minimal treatment-related toxicity.