The effect of rituximab in first line therapy to results of autologus haematopoietic stem cell transplantation in relapsed non-Hodgkin's lymphoma patients

Introduction: The response rates to salvage therapy and high dose chemotherapy with autologus hematopoietic transplantation of relapsed non Hodgkin lymphoma(NHL) patients treated with rituximab in first line therapy, is still debate. Patients and methods: We retrospectively analyzed 76 patients (median age 42(17-63), Male/Female:48/28) who relapsed or progressed after first line therapy and had high dose chemotherapy, autologus transplantation. We grouped them as patients treated with rituximab (R(+) n:21) and without rituximab (R(-) n:54) in first line therapy. The major group of the patients were diffuse large B cell lymphoma. Median time from diagnosis to transplantation was12 months (5-151) in R (-) group and 20 months (5-54) in R (+) group. Results: The median age of R (+) patients was slightly older than R(-) patients. Overall response (CR+PR) to salvage therapy before transplantation was 62% in R (+) group and 44% in R (-) group, p = 0.448. Overall response after transplantation was 76% in both groups. Posttransplantation 2 years survival of all patients was 50% ± 7% with median 21 months of follow up. Posttransplantation 2 years survival according to groups was statistically insignificant between two groups R (+); 35% ± 26%, R(-) 51%+8%, p = 0.72. Diffuse large B cell lymphoma patients were analyzed spesifically; rituximab was found with no effect to the posttransplantation responses and survival rates; 1 year survival was 71% ± 14% in R (+) group and 61% ± 8% in R (-) group, P = 0.838. Twenty nine patients (RR+) treated with rituximab both in first and second line therapy was compared with 46 patients(RR-) who did not; 2 years survival was 40% ± 15% in RR(+) group and %55 ± 8% in RR (-) group, p = 0,72. Conclusion: In conclusion, we did not find a positive effect of rituximab in first line treatment to responses of salvage therapy and posttransplantation period. Our rituximab positive group was older and had less patients than rituximab negative group. Further randomized, prospective studies with larger patient groups are needed.