Publication Date:
2018-11-29
Description:
Background: Treatment outcomes for diffuse large B-cell lymphoma (DLBCL) have improved with the addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, up to 40% of patients with DLBCL do not achieve durable remission and develop relapsed or refractory disease. The standard treatment for relapsed or refractory patients is salvage chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT). But long-term survival outcome is still unsatisfactory. So, we investigated survival outcome and prognostic factors for patients with relapsed or refractory DLBCL who received salvage chemotherapy followed by ASCT. Methods: We retrospectively identified 117 patients with relapsed or refractory DLBCL who received salvage chemotherapy and ASCT at Asan Medical Center between January 2008 and December 2017. Survival outcomes were estimated using the Kaplan-Meier method and compared using the log-rank test. The Cox proportional hazards regression was used to analyses prognostic factor for survival outcomes. Results: The median age at ASCT was 52 years (range, 17 to 69 years) with the study group comprised of 47 women (40.2%) and 70 men (59.8%). Sixty-one patients (52.1%) received etoposide, cytarabine, cisplatin, and methylprednisolone (ESHAP) salvage chemotherapy; 12 (10.3%) vincristine, methotrexate, ifosfamide, etoposide, cytarabine, cyclophosphamide, doxorubicin, and dexamethasone (BNHL); 11 (9.4%) ifosfamide, carboplatin, etoposide, and dexamethasone (ICE-D); and the remaining 33 (28.2%) other regimens. The ASCT conditioning regimens were thiotepa, busulfan, and cyclophosphamide (TBC) in 27 patients (23.1%), busulfan, etoposide, and cyclophosphamide (BuCyE) in 68 (58.1%), and other regimes in 22 (18.8%). After receiving ASCT, 86 patients (73.5%) achieved complete response; 17 (14.5%) partial response; and 13 (11.1%) stable disease or progressive disease. At a median follow-up of 14.1 months (range, 0.2 to 117.6 months), 81 patients had an event and 64 patients had died. The two-year progression-free survival (PFS) and overall survival (OS) for all study patients were 30.3% and 48.2%, respectively. A univariate analysis showed the performance status at ASCT (HR 1.7, 95%CI 1.0 to 2.8, p=0.04), stage at ASCT (HR 2.7, 95%CI 1.5 to 4.9, p
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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