International Journal of Hematology

DOI: 10.1007/s12185-019-02772-1 Pages: 256-266

High-dose therapy and autologous stem cell transplantation for relapsed or high-risk diffuse large B-cell lymphoma: a nationwide survey

1. National Cancer Center Hospital, Department of Hematopoietic Stem Cell Transplantation

2. Okinawa Chubu Hospital, Department of Hematology and Oncology

3. Japanese Red Cross Kyoto Daiichi Hospital, Department of Hematology

4. Aichi Cancer Center Hospital, Department of Hematology and Cell Therapy

5. Niigata Cancer Center Hospital, Department of Hematology and Oncology

6. Aichi Medical University School of Medicine, Department of Promotion for Blood and Marrow Transplantation

7. Aichi Cancer Center Research Institute, Division of Epidemiology and Prevention

8. Shimane University Hospital, Department of Oncology and Hematology

9. Komagome Hospital, Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center

10. Nagoya University School of Medicine, Department of HSCT Data Management and Biostatistics

Correspondence to:
Sung-Won Kim
Email: skim@ncc.go.jp

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Abstract

To investigate the use of high-dose therapy and autologous stem cell transplantation (ASCT) for relapsed or high-risk diffuse large B-cell lymphoma (DLBCL) between 1990 and 2007, we conducted a nationwide survey using the registry database of the Japan Society for Hematopoietic Cell Transplantation. Of the 1222 patients in the database, 576 (47%) received ASCT in first complete remission (CR1), 140 (12%) in first partial remission, 281 (23%) in sensitive relapse, 150 (12%) in resistant or sensitivity-unknown relapse, and 75 (6%) in primary refractory status. With a median follow-up of 22 months, the 2-year overall survival (OS) and progression-free survival rates were 71% and 68%, respectively. The cumulative incidences of 2-year non-relapse mortality and relapse/progression were 6% and 26%, respectively. Relapse/progression after ASCT in the rituximab era (2002–2007) was significantly lower than that in the pre-rituximab era (1990–2001; P < 0.001). Older age, male gender, poor performance status at ASCT, non-CR1 at ASCT, ASCT performed in 1990–2001, and LEED or MCEC regimen were adverse predictors of OS. Because ASCT for newly diagnosed high-risk DLBCL has not been performed recently, a registry database study to assess the impact of ASCT for relapsed or refractory DLBCL in the rituximab era is warranted.

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