No benefit of autologous stem cell transplantation as consolidation for high and high-intermediate risk diffuse large B-cell lymphoma in 1.CR after R-CHOP therapy--a single-centre experience

Objectives: the role of high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) for patients (pts) with high and high-intermediate (H/HI) risk diffuse large B-cell lymphoma (DLBCL) in 1.CR was not clearly defined especially after addition of rituximab (R) to first line chemotherapy (CHT) and the use of rituximab also as maintenance therapy. Therefore, we retrospectively analysed outcome of pts treated in our transplant centre with HDT and ASCT for H/HI risk DLBCL in 1.CR after 6-8 cycles of R-CHOP-21 chemotherapy and we compared their outcome with a control group of pts with H/HI risk DLBCL in 1.CR treated only with chemoimmunotherapy. Patients and methods: between 2003 and 2008 (median followup 38 months, range 13-64 months) 17 consecutive pts with median of age 48 years (range 24-63 years) with H/HI risk DLBCL in 1.CR after 6-8 cycles of R-CHOP-21 underwent HDT (BEAM) and ASCT. The median of time from diagnosis to ASCT was 8 months (range 5-13 months). Source of stem cells was peripheral blood and median of infused CD34+ cells was 4,36x106/kg (range 3,28-9,94x106/kg). The control group consisted of 11 consecutive pts with H/HI risk DLBCL in 1.CR treated only with chemoimmunotherapy (6-8 cycles of R-CHOP-21, 45% maintenance therapy with rituximab). The control group except for the older age did not differ in any prognostic parameters. Results: in the transplanted group 15 pts (88%) are alive in CR. 2 pts (12%) relapsed and died. No patient died due to transplantrelated mortality (TRM). The estimated probabilities of 4-years disease-free survival (DFS) and overall survival (OS) were 87% and 86%. In the chemoimmunotherapy treated group 10 pts (91%) are alive in CR. 1 patient (9%) relapsed and died. The estimated probabilies of 4-years DFS and OS were 75% and 67%. We did not observe between both groups any significant difference in cumulative relapse incidence (p = 1,00), DFS (p = 0,91) and OS (p = 0,89). Conclusion: our data suggest that HDT with ASCT in pts with H/HI risk DLBCL in 1.CR after R-CHOP chemotherapy was well-tolerated with no TRM death but in comparison with pts treated only with chemoimmunotherapy we did not observe any improvement of outcome among transplanted pts. Of course relatively lower number of evaluated pts and retrospective type of analysis could influence our results and only prospective randomized studies can finally define the role of frontline HDT with ASCT for H/HI risk DLBCL in 1.CR after chemoimmunotherapy.