Autologous Stem Cell Transplantation in the Treatment of Patients with Relapsed-Refractory

AUTOLOGOUS STEM CELL TRANSPLANTATION IN THE TREATMENT OF PATIENTS WITH RELAPSED-REFRACTORY DIFFUSE LARGE B CELL LYMPHOMA: A SINGLE-CENTER EXPERIENCE

Vinko Roso1, Martina Bogeljić Patekar1, Vibor Milunović1, Delfa Radić-Krišto1, Ana Planinc-Peraica1,2, Slobodanka Ostojić Kolonić1,2

1 Department of Hematology, Clinical Hospital Merkur, Zagreb, Croatia

2 School of Medicine, Zagreb, Croatia

Presenter: Martina Bogeljić Patekar, Medical Doctor, Resident of Hematology

Address: Department of Hematology, Clinical Hospital Merkur, Zajčeva 19, 100000 Zagreb, Croatia

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phone:+38512253222

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Objectives: The objective of this paper is to present the results of treatment of patients diagnosed with relapsed-refractorydiffuse large B cell lymphoma (RR-DLBCL) treatedwith high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in a one center in the period between 2000. - 2013. and to determine prognostic factors associated with overall survival (OS).RR-DLBCL accounts for approximately one-third of patients with DLBCL and continues to be a challenge to the treating hematologists.

Methods: In this retrospective study weincluded a total of 62 patients, of whom 45.2% were men (28), with median age 50 years (range 21-71 years). All patients were treated with salvage high-dose chemotherapy (HDC) and ASCT.

Results: In the first line of treatment 56.5% (35) received CHOP chemotherapy, and 40.3% (25) received CHOP-R regimen, while one patient received PRO MACE regimen (1.6%) and one patient was treated with R-HyperCVAD (1.6%). 77.4% of patients received one line of treatment before HDC. Rituximab in a first-line treatment was received by 41.9% patients (26). Median time in months from diagnosis to ASCT was 11.6 months (range from 5 months to 11 years). Before beginning of HDC24% of patients (15) werein a delayed relapse (more than one year from diagnosis), 7% of patients (4) were in early relapse (within one year from diagnosis), 21% of patients (13) achievedpartial remission (PR) after the first line treatment, and 48% of patients (30) had refractory disease. A total of 71% of patients (44) received mini-BEAM as HDC and 13% (8) patients received rituximab as addition to HDC as a part of other protocols used in the other 29% of patients (18). All patients received BEAM myeloablative chemotherapy followed by ASCT. Before the start of ASCT 51.6% (32) patients achieved either CR or PR. After ​​ASCT total of 62.9% (39) patients achieved complete remission (CR), 14.5% (19) partial remission (PR), 12.9% (8) had stable disease (SD) and 9,7% (6) had progression of disease (PD). Median OS in our group of patients was 37 months. After 56 months follow-up 46.8% of patients were alive with no signs of disease. Median event-free survival (EFS) in our group was 17 months with 41.9% of patients were alive without progression or signs of relapse after 52 months of follow-up. Factors associated with the OS were secondary IPI (p = 0.004), clinical stage (p = 0.038), disease state before HDC (p <0.001) and response toHDC (p = 0.041). Gender, age, use of rituximab and the presence of B symptoms were not significantly associated with OS in our group.

Conclusions:We presented our results of treatment of RR-DLBCL withHDC/ASCT with high rates of remission. Factors associated with overall survival were secondary IPI, clinical stage, disease state before HDC and response to HDC before ASCT. Risk factors previously associated with OSas gender, age of patients, the use of rituximab and the presence of B symptoms in our study proved to be not significantly associated probably due to the small number of events. The gold standard regimen for salvage chemotherapy still does not exist. In line with previous studies, our results suggest that HDC followed by ASCT remains the standard treatment of chemosensitive RR-DLBCL but advances are needed to improve the outcomes of patients with RR-DLBCL.