• Mehdi Hamadani, Parameswaran N Hari, Ying Zhang, Jeanette Carreras, Görgün Akpek, Mahmoud D Aljurf, Ernesto Ayala, Veronika Bachanova, Andy I Chen, Yi-Bin Chen, Luciano J Costa, Timothy S Fenske, César O Freytes, Siddhartha Ganguly, Mark S Hertzberg, Leona A Holmberg, David J Inwards, Rammurti T Kamble, Edward J Kanfer, Hillard M Lazarus, David I Marks, Taiga Nishihori, Richard Olsson, Nishitha M Reddy, David A Rizzieri, Bipin N Savani, Melhem Solh, Julie M Vose, Baldeep Wirk, David G Maloney, Sonali M Smith, Silvia Montoto, Wael Saber, Onder Alpdogan, Amanda Cashen, Christopher Dandoy, Robert Finke, Robert Gale, John Gibson, Jack W Hsu, Nalini Janakiraman, Mary J Laughlin, Michael Lill, Mitchell S Cairo, Reinhold Munker, Phil A Rowlings, Harry C Schouten, Thomas C Shea, Patrick J Stiff, and Edmund K Waller.
• Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: mhamadani@mcw.edu.
• Biol. Blood Marrow Transplant. 2014 Nov 1; 20 (11): 1729-36.

AbstractThe poor prognosis for patients with diffuse large B cell lymphoma (DLBCL) who relapse within 1 year of initial diagnosis after first-line rituximab-based chemo-immunotherapy has created controversy about the role of autologous transplantation (HCT) in this setting. We compared autologous HCT outcomes for chemosensitive DLBCL patients between 2000 and 2011 in 2 cohorts based on time to relapse from diagnosis. The early rituximab failure (ERF) cohort consisted of patients with primary refractory disease or those with first relapse within 1 year of initial diagnosis. The ERF cohort was compared with those relapsing >1 year after initial diagnosis (late rituximab failure [LRF] cohort). ERF and LRF cohorts included 300 and 216 patients, respectively. Nonrelapse mortality (NRM), progression/relapse, progression-free survival (PFS), and overall survival (OS) of ERF versus LRF cohorts at 3 years were 9% (95% confidence interval [CI], 6% to 13%) versus 9% (95% CI, 5% to 13%), 47% (95% CI, 41% to 52%) versus 39% (95% CI, 33% to 46%), 44% (95% CI, 38% to 50%) versus 52% (95% CI, 45% to 59%), and 50% (95% CI, 44% to 56%) versus 67% (95% CI, 60% to 74%), respectively. On multivariate analysis, ERF was not associated with higher NRM (relative risk [RR], 1.31; P = .34). The ERF cohort had a higher risk of treatment failure (progression/relapse or death) (RR, 2.08; P < .001) and overall mortality (RR, 3.75; P <.001) within the first 9 months after autologous HCT. Beyond this period, PFS and OS were not significantly different between the ERF and LRF cohorts. Autologous HCT provides durable disease control to a sizeable subset of DLBCL despite ERF (3-year PFS, 44%) and remains the standard-of-care in chemosensitive DLBCL regardless of the timing of disease relapse.Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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