scholarly journals High-dose therapy and autologous stem cell transplantation may only be applicable to selected patients with secondary CNS diffuse large B-cell lymphoma

2016 ◽  
Vol 178 (6) ◽  
pp. 991-994 ◽  
Author(s):  
Chan Yoon Cheah ◽  
David Joske ◽  
Gavin Cull ◽  
Michael Gilbertson ◽  
Stephen S. Opat ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
B Cell ◽  
Autologous Stem Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Large B Cell Lymphoma ◽  
Large B Cell

High-Dose Therapy and Autologous Stem Cell Transplantation for Chemoresistant Diffuse Large B Cell Lymphoma: The Seattle Experience.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5097-5097
Author(s):  
Jonathan A. Gutman ◽  
Ted A. Gooley ◽  
Jacob Nourigat ◽  
John M. Pagel ◽  
Oliver W. Press ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose ◽  
High Dose Therapy ◽  
Large B Cell Lymphoma ◽  
One Year ◽  
Large B Cell

Abstract High-dose therapy (HDT) with autologous stem cell transplantation (ASCT) is the standard treatment for patients with chemosensitive relapsed or refractory diffuse large B cell lymphoma (DLBCL). Unfortunately, there are few established options for DLBCL patients with chemoresistant disease and data regarding the efficacy of ASCT in this setting are limited. We conducted a retrospective review of patients with chemoresistant DLCBL undergoing ASCT at our Center with the goal of identifying variables associated with better outcomes. Between March 1990 and September 2004, 40 pts underwent ASCT for chemoresistant DLBCL, defined as < 50% reduction in the size of the tumor with the chemotherapy regimen immediately preceding ASCT. The median age of these pts was 44 years (range 17–69). The number of prior chemotherapies was 2 (n=21), 3 (n=15), or 4 (n=4). Twenty-two (55%) patients had progressive disease (PD) following their pre-transplant salvage therapy and 18 (45%) patients had stable disease (SD). Sixteen patients (40%) had never achieved at least a partial response (PR) to any previous chemotherapy. Median time from diagnosis to ASCT was 13 months (range 6–98). The international prognostic index (IPI) at time of ASCT was available for 33 patients and was 0–1 for 10 patients and 2–4 for 23 patients. Twenty-four patients (60%) underwent conditioning with combined chemotherapy and radiation and 16 patients (40%) received chemotherapy only. All patients received mobilized peripheral blood stem cells. Thirty-three patients have died as of last contact, with an estimated 3-year overall survival (OS) of 21% and a median follow-up of 4.0 years among the 7 survivors. Among 34 patients who did not have refractory disease following transplant, estimated 3-year progression free survival (PFS) was 12%. Causes of death include PD (n=24), ASCT toxicity (n=3), and late infection (n=2). After adjusting for year of transplant, patients with a remission duration of less than one year following initial treatment and patients whose remission duration exceeded one year had a reduced, but not statistically significant, hazard of mortality compared to patients that never responded (remission <1 year: HR=0.28, p=0.21; > 1 year: HR=0.14, p=0.08) (Figure 1). The hazard of death decreased with transplants performed more recently (p=0.03). There was no statistically significant association between outcomes and age at transplant, number of prior chemotherapy regimens, conditioning regimen (radiation vs non-radiation based), disease status at ASCT (progressive vs stable), or pre-ASCT IPI (available for 33 patients). Though outcomes following ASCT for chemoresistant DLBCL are poor, a minority of patients with prolonged remission prior to initial relapse may achieve long term survival following HDT. Additional strategies are needed to treat this disease. Figure Figure

scholarly journals Primary Mediastinal Large B-Cell Lymphoma: A Single Center Experience in Korea.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5013-5013
Author(s):  
Heui June Ahn ◽  
Yoo Jin Cho ◽  
Myoung Joo Kang ◽  
Dae Ro Choi ◽  
Shin Kim ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
B Cell ◽  
Autologous Stem Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Abstract 5013 Introduction Primary mediastinal large B-cell lymphoma (PMBCL) was formally established as a distinct subtype of diffuse large B-cell lymphoma (DLBCL). Some studies indicated that patients with PMBCL have an aggressive clinical course with short median survival but more recent studies reported a relatively good response rate and survival. Therefore, controversies still exist regarding the response to therapy and prognosis of patients with PMBCL. Patients and methods Between July 1993 and July 2008, a total of 26 patients with PMBCL were identified at Asan Medical Center, Seoul Korea. We retrospectively reviewed the clinic-pathologic features and clinical outcomes of them in comparison with 597 patients diagnosed with non-mediastinal DLBCL during the same period. Result Out of the 26 patients, 17 (65.4%) were females and 9 (34.6%) males, while out of the 597 patients, 257 (43.0%) were females and 340 (57.0%) males (p=0.025). The median age of the PMBCL patients was 31.5 years old (range 15-78 years old), while that of the DLBCL patients was 56.0 years old (range 15-85 years old). Out of the 26 patients, 14 (53.8%) had a Ann Arbor stage III or IV disease, 7 (26.9%) had B symptoms, and by the IPI, 11 were in low, 9 in low intermediate, 2 in high-intermediate and 4 in high risk group. Out of 24 patients treated with front-line therapy CHOP or R-CHOP, 17 (70.8%) reached a CR, while 1 PR patient reached a CR after being treated with high-dose chemotherapy followed by autologous stem cell transplantation. Five refractory patients were treated with high-dose chemotherapy followed by autologous stem cell transplantation, but among them only one reached a CR and 4 died of disease progression. With a median follow-up of 41.5 months (range 1-92 months), 5-year survival rates of PMBCL and non-mediastinal DLBCL patients were 69% and 65.7%, respectively (p=0.982, Log Rank). Conclusion There was no difference between PMLBL and non-mediastinal DLBCL in terms of clinical features and outcomes. Disclosures No relevant conflicts of interest to declare.

Disease characteristics of diffuse large B-cell lymphoma predicting relapse after autologous stem cell transplantation.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19030-e19030
Author(s):  
Daria Gaut ◽  
David Oveisi ◽  
Grant Howell ◽  
Tahmineh Romero ◽  
Gary J. Schiller
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
B Cell ◽  
Cell Transplantation ◽  
Autologous Stem Cell Transplantation ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Large B Cell Lymphoma ◽  
Large B Cell

e19030 Background: High-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT) is standard of care for patients with diffuse large B-cell lymphoma (DLBCL) whose diseases relapse after, or are refractory to, first-line therapy. However, there are still high rates of relapse following ASCT, and non-relapse mortality also affects survival rates. Prognostic indicators are therefore needed to identify the best candidates for HDC/ASCT. Methods: We retrospectively analyzed medical records of 111 DLBCL patients (78 relapsed, 33 refractory) who underwent HDC/ASCT at the University of California Los Angeles from 2010-2015. Results: The median age at the time of ASCT was 61 years (IQR 51.5-68.0). 80 patients (72%) had DLBCL in a complete response at the time of ASCT, and the majority (98 patients, 88%) had ECOG performance status of 0-1. After a median follow-up of 4.6 years (IQR 2.2-8.1), the 1-year progression-free survival (PFS) rate was 77.3% (95% CI 69.7%-85.7%) and the 1-year overall survival (OS) rate was 84.7% (95% CI 78.2%-91.7%). 41 patients (37%) relapsed after ASCT with a median PFS of 11 months (IQR 5.0-20.0). 37 patients (33%) died, 23 (21%) from relapse mortality, 11 (10%) from non-relapse mortality, and 3 (3%) from unknown cause of death. In univariate analysis, 2 variables were significantly associated with curtailed PFS and OS: higher number (≥ 3 vs < 3) of chemotherapy regimens prior to ASCT (HR 2.20, 95% CI 1.19-4.06, p = 0.013 for PFS; HR 2.01, 95% CI 1.06-3.84, p = 0.036 for OS) and higher International Prognostic Index (IPI) score at time of ASCT (trend HR 1.61, 95% CI 1.10-2.35, p = 0.018 for PFS; trend HR 2.02, 95% CI 1.37-2.98, p = 0.001 for OS). Higher National Comprehensive Cancer Network (NCCN) IPI score at time of ASCT (trend HR 2.29, 95% CI 1.34-3.90, p = 0.002) and refractory versus relapsed disease (HR 1.99, 95% CI 1.04-3.82, p = 0.038) were also significantly associated with curtailed OS. Conclusions: Our study suggests that IPI, while a validated prognostic tool at diagnosis, is also a prognostic indicator at time of ASCT for PFS and OS. NCCN IPI at time of ASCT was also found to be predictive of OS. Age-adjusted IPI was not associated with outcome following ASCT.

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