Work

Survival after autologous transplantation to treat diffuse large B-cell lymphoma with a history of central nervous system involvement, bone marrow involvement, or histological transformation

Year: 2005

Type: article

Abstract: Background: Patients with diffuse large B-cell lymphoma (DLBCL) who present with extranodal involvement or histological transformation from low-grade disease have lower rates of survival after conventional-dose therapy. The impact of these features on outcomes after high-dose therapy with autologous transplantation was investigated. Methods: We retrospectively reviewed the outcomes of 64 consecutive patients receiving autologous transplantation from 1995 to 2003 for the treatment of DLBCL. Variables analyzed were age, gender, histological transformation, history of bone marrow involvement, history of central nervous system (CNS) involvement, time from diagnosis to transplantation, number of pretransplantation regimens, chemosensitivity before transplantation, conditioning regimen, year of transplantation, and the use of peripheral blood or bone marrow stem cells. Survivals were estimated by the Kaplan-Meier method. The Cox proportional hazards regression model was used to test the significance of factors on survival. Correlation between variables was tested with Spearman’s rank coefficient. Results: The median age at transplantation was 53.5 years. The median overall survival was 3.3 years, disease-free survival was 1.2 years, and 100-day mortality was 7%. Among a total of 29 patients, 12 had a history of CNS involvement, 10 had a history of bone marrow involvement, and 12 had transformed from low-grade lymphoma. A Cox regression analysis performed to assess multivariate factors for survival suggested <2 regimens before transplantation (log-rank test, P= .05) and the lack of BEAM as the conditioning regimen (log-rank test, P= .02) as significant for overall survival. However, the use of BEAM was highly associated with older age (r2= .42; P= .001) and more prior chemotherapy regimens (r2 =.24; P= .05). A history of extranodal involvement, including prior CNS involvement (P= .84) or bone marrow involvement (P= .52), was not associated with lower survival by univariate analysis. No significant association was found between survival and a history of transformation (P= .48). Conclusions: A history of CNS involvement, bone marrow involvement, or histological transformation was not associated with lower rates of survival among patients undergoing autologous transplantation for DLBCL. Patients who present with these clinical presentations remain candidates for autologous transplantation.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2004.12.229