Role of frontline autologous stem cell transplantation in young, high-risk diffuse large B-cell lymphoma patients
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Background/Aims: Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto- HSCT. Methods: We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score ≥ 2. From 2006 to 2011, among the 150 DLBCL patients aged ≤ 60 years who were treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), 23 high-risk patients with a complete response (CR) were treated with auto-HSCT. For comparison, we selected 35 well-matched high-risk patients with CR who completed R-CHOP treatment alone. In addition, there were 81 low-risk patients and 11 refractory patients. Results: DLBCL patients with an aaIPI score ≥ 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone. Conclusions: We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level
Abstract
Background/Aims: Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto- HSCT. Methods: We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score ≥ 2. From 2006 to 2011, among the 150 DLBCL patients aged ≤ 60 years who were treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), 23 high-risk patients with a complete response (CR) were treated with auto-HSCT. For comparison, we selected 35 well-matched high-risk patients with CR who completed R-CHOP treatment alone. In addition, there were 81 low-risk patients and 11 refractory patients. Results: DLBCL patients with an aaIPI score ≥ 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone. Conclusions: We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level
참고문헌 (31)
- Philip T, "High-dose therapy and autologous bone marrow transplantation after failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-Hodgkin’s lymphoma", N Engl J Med, 316, pp.1493~1498 (1987)
- Blay J, "The International Prognostic Index correlates to survival in patients with aggressive lymphoma in relapse: analysis of the PARMA trial. Parma Group", Blood, 92, pp.3562~3568 (1998)
- Haioun C, "Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin’s lymphoma: final analysis of the prospective LNH87-2 protocol--a groupe d’Etude des lymphomes de l’Adulte study", J Clin Oncol, 18, pp.3025~3030 (2000)
- Santini G, "VACOP-B versus VACOP-B plus autologous bone marrow transplantation for advanced diffuse non-Hodgkin’s lymphoma: results of a prospective randomized trial by the non-Hodgkin’s Lymphoma Cooperative Study Group", J Clin Oncol, 16, pp.2796~2802 (1998)
- Milpied N, "Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support", N Engl J Med, 350, pp.1287~1295 (2004)
- Greb A, "High-dose chemotherapy with autologous stem cell support in first-line treatment of aggressive non-Hodgkin lymphoma: results of a comprehensive meta-analysis", Cancer Treat Rev, 33, pp.338~346 (2007)
- Gisselbrecht C, "Shortened first-line high-dose chemotherapy for patients with poor-prognosis aggressive lymphoma", J Clin Oncol, 20, pp.2472~2479 (2002)
- Martelli M, "Early autologous stem-cell transplantation versus conventional chemotherapy as front-line therapy in high-risk, aggressive non-Hodgkin’s lymphoma: an Italian multicenter randomized trial", J Clin Oncol, 21, pp.1255~1262 (2003)
- Vitolo U, "Rituximab dose-dense chemotherapy followed by intensified highdose chemotherapy and autologous stem cell transplantation (HDC+ASCT) significantly reduces the risk of progression compared to standard rituximab dose-dense chemotherapy as first line treatment in young patients with high-risk (aa-IPI 2-3) diffuse large B-cell lymphoma (DLBCL): final results of phase III randomized trial DLCL04 of the Fondazione Italiana Linfomi (FIL)", 54th ASH Annual Meeting Abstracts 2012, pp.688~ (2012), American Society of Hematology
- Cortelazzo S, "Chemoimmunotherapy with R-CHOP or high dose sequential therapy with autologous stem cell transplantation (R-HDS) for high risk diffuse large B-cell lymphomas patients: results of the randomized R-HDS0305 trial by Gruppo Italiano Terapie Innovative Nei Linfomi (GITIL)", 54th ASH Annual Meeting Abstracts 2012, pp.746~ (2012), American Society of Hematology
- Stiff PJ, "Randomized phase III U.S.", Canadian intergroup trial (SWOG S9704) comparing CHOP ± R for eight cycles to CHOP ± R for six cycles followed by autotransplant for patients with high-intermediate (H-Int)or high IPI grade diffuse aggressive non-Hodgkin lymphoma (NHL), 2011, pp.29(Suppl), abstr8001~
- Stiff PJ, "Autologous transplantation as consolidation for aggressive non-Hodgkin’s lymphoma", N Engl J Med, 369, pp.1681~1690 (2013)
- Pfreundschuh M, "CHOPlike chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group", Lancet Oncol, 7, pp.379~391 (2006)
- Coiffier B., "Rituximab in combination with CHOP improves survival in elderly patients with aggressive non-Hodgkin’s lymphoma", Semin Oncol, 29, pp.18~22 (2002)
- Gang AO, "R-CHOEP-14improves overall survival in young high-risk patients with diffuse large B-cell lymphoma compared with R-CHOP-14: a population-based investigation from the Danish Lymphoma Group", Ann Oncol, 23, pp.147~153 (2012)
- Juweid ME, "Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma", J Clin Oncol, 25, pp.571~578 (2007)
- The International Non-Hodgkin’s Lymphoma Prognostic Factors Project, "A predictive model for aggressive non-Hodgkin’s lymphoma", N Engl J Med, 329, pp.987~994 (1993)
- Hamlin PA, "Age-adjusted International Prognostic Index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma", Blood, 102, pp.1989~1996 (2003)
- Jardin F, "Diffuse large B-cell lymphomas with CDKN2A deletion have a distinct gene expression signature and a poor prognosis under R-CHOP treatment: a GELA study", Blood, 116, pp.1092~1104 (2010)
- Papageorgiou SG, "Isolated central nervous system relapses in primary mediastinal large B-cell lymphoma after CHOP-like chemotherapy with or without Rituximab", Hematol Oncol, 31, pp.10~17 (2013)
- Wolff JE, "High-dose chemotherapy in childhood brain tumors", Onkologie, 27, pp.239~245 (2004)
- DE Ioris MA, "Comparison of two different conditioning regimens before autologous transplantation for children with high-risk neuroblastoma", Anticancer Res, 32, pp.5527~5533 (2012)
- Lee SC, "Excessive toxicity of once daily i.v. BU, melphalan and thiotepa followed by auto SCT on patients with non-Hodgkin’s lymphoma", Bone Marrow Transplant, 45, pp.801~802 (2010)
- Lee JL, "Veno-occlusive disease of the liver after busulfan, melphalan, and thiotepa conditioning therapy: incidence, risk factors, and outcome", Biol Blood Marrow Transplant, 5, pp.306~315 (1999)
- Kaiser U, "Randomized study to evaluate the use of high-dose therapy as part of primary treatment for “aggressive” lymphoma", J Clin Oncol, 20, pp.4413~4419 (2002)
- Schmitz N, "Conventional chemotherapy (CHOEP-14) with rituximab or high-dose chemotherapy (MegaCHOEP) with rituximab for young, high-risk patients with aggressive B-cell lymphoma: an open-label, randomised, phase 3 trial (DSHNHL 2002-1)", Lancet Oncol, 13, pp.1250~1259 (2012)
- Alousi AM, "Disease staging with positron emission tomography or gallium scanning and use of rituximab predict outcome for patients with diffuse large B-cell lymphoma treated with autologous stem cell transplantation", Br J Haematol, 142, pp.786~792 (2008)
- Filmont JE, "The impact of pre- and post-transplantation positron emission tomography using 18-fluorodeoxyglucose on poor-prognosis lymphoma patients undergoing autologous stem cell transplantation", Cancer, 110, pp.1361~1369 (2007)
- FDG-PET a valid alternative to conventional diagnostic methods?, "J Clin Oncol", 2001, 414~419
- Derenzini E, "Pretransplantation positron emission tomography scan is the main predictor of autologous stem cell transplantation outcome in aggressive B-cell non-Hodgkin lymphoma", Cancer, 113, pp.2496~2503 (2008)
- Schot BW, "Early FDG-PET assessment in combination with clinical risk scores determines prognosis in recurring lymphoma", Blood, 109, pp.486~491 (2007)