Since significance of up-front autologous stem cell transplantation (ASCT) for aggressive lymphoma has not been established, we retrospectively analyzed the outcome of ASCT for higher risk diffuse large B-cell lymphoma (DLBL) in the first remission.Patients and methods
Among 61 patients with DLBL classified as high or high-intermediate risk using international prognostic index, ASCT was carried out in 37 patients in the first remission induced by CHOP regimen. They consist of 22 male and 15 female. Their median age was 66.5 (range 23–73). Stem cells were mobilized by etoposide and conditioning regimen consisted of ranimustine, carboplatin, etoposide, and cyclophosphamide. Rituximab was used in 11 patients. The survival outcome of ASCT was compared with that of 10 patients who rejected ASCT.Results
1.1–27.6 × 106/kg (median 6.9) of CD34-positive cells was infused. The recovery of neutrophils or platelet was immediate. There was no therapy-related death. Febrile neutropenia was observed in 24 patients (64.9%). Each of MRSA sepsis, cytomegalovirus antigenemia, and hemorrhagic duodenal ulcer was occurred in one patient, respectively. Five-year disease-free survival was significantly superior to that of patients without ASCT (P = 0.01 by the log-rank test). None of use of rituximab, age, extranodal lesion was associated with the survival rate.Discussion
Survival benefit of ASCT in the first remission of higher risk DLBL was suggested. Toxicity was generally tolerable. Therefore, up-front ASCT might more widely be applied.