The international prognostic index at relapse predicts autologous stem cell transplantation outcome for aggressive non-Hodgkin's lymphoma in second remission or chemosensitive first relapse

Abstract

6661 Background: Autologous stem cell transplantation (ASCT) has become the standard treatment for patients with relapsed aggressive non-Hodgkin's lymphoma (NHL) responding to conventional salvage chemotherapy. Nevertheless, greater than half of these patients will relapse and ultimately die. The international prognostic index (IPI) was developed to identify patients with aggressive NHL who have different risks for death. The objective of the present study was to investigate the prognostic value of the IPI at relapse for patients with aggressive NHL undergoing ASCT. Methods: Eighty patients, median age 47 years (range 19–68 years), with aggressive NHL (diffuse small, mixed, and large cell, immunoblastic, and anaplastic B-cell) in second complete remission (CR, n = 50) or first chemosensitive relapse (n = 30) were treated between 1984 and 2002 with ASCT. Clinical features predictive of overall survival (OS) and progression-free survival (PFS) were analyzed. Results: Post ASCT, CR was achieved in 73 patients (91%). With a median follow-up of 5 years (range 205 days to 14 years), OS and PFS at 5 years were 37% (95% CI 26–48) and 37% (95% CI 26–48), respectively. Two risk groups with significantly different OS and PFS were identified by the IPI at relapse. The high-risk group (3, 4, or 5 IPI factors) had 3.2 times (95% CI 1.5–6.6, p = .002) the risk of death and 3.5 times (95% CI 1.6–7.3, p = .001) the risk of relapse as the low-risk group (0, 1, or 2 IPI factors). In Cox regression analysis, high-risk IPI status (RR 3.8, 95% CI 1.7–8.4, p = .001) and bone marrow (BM) involvement at diagnosis (RR 2.9, 95% CI 1.3 - 6.3, p = .009) were independent predictors for poor OS. Similarly, high-risk IPI status (RR 3.9, 95% CI 1.8–8.7, p = .001) and BM involvement (RR 4.2, 95% CI 1.8–9.4, p = .001) were independent predictors for poor PFS. Conclusions: The IPI at relapse predicts OS and PFS following ASCT for patients with aggressive NHL in second remission or chemosensitive first relapse. Patients with high-risk IPI status at relapse should be considered for novel therapeutic approaches. No significant financial relationships to disclose.