Upfront high‑dose chemotherapy combined with autologous stem cell transplantation: Potential survival benefit for patients with high‑risk diffuse large B‑cell lymphoma

Nakaya,Aya; Fujita,Shinya; Satake,Atsushi; Nakanishi,Takahisa; Azuma,Yoshiko; Tsubokura,Yukie; Hotta,Masaaki; Yoshimura,Hideaki; Ishii,Kazuyoshi; Ito,Tomoki; Nomura,Shosaku

doi:10.3892/ol.2017.6589

Upfront high‑dose chemotherapy combined with autologous stem cell transplantation: Potential survival benefit for patients with high‑risk diffuse large B‑cell lymphoma

Authors:
- Aya Nakaya
- Shinya Fujita
- Atsushi Satake
- Takahisa Nakanishi
- Yoshiko Azuma
- Yukie Tsubokura
- Masaaki Hotta
- Hideaki Yoshimura
- Kazuyoshi Ishii
- Tomoki Ito
- Shosaku Nomura
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Affiliations: First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573‑1010, Japan
Published online on: July 15, 2017 https://doi.org/10.3892/ol.2017.6589
Pages: 3803-3808

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Abstract

In patients with diffuse large B‑cell lymphoma (DLBCL) classified as high‑intermediate risk or high risk using the International Prognosis Index, the efficacy of high‑dose chemotherapy combined with upfront autologous stem cell transplantation (HDT/ASCT) remains controversial in the rituximab era. In the present study, 27 patients who had been treated with HDT/ASCT in an upfront setting were retrospectively analyzed, and compared with 77 patients with similar characteristics who had received conventional chemotherapy without HDT/ASCT (the non‑upfront setting). The 3‑year overall survival and progression‑free survival rates in the upfront setting were 88.5% (P=0.0134 vs. non‑upfront setting) and 68.4% (P=0.113 vs. non‑upfront setting), respectively; in the non‑upfront setting, the 3‑year overall survival and progression‑free survival rates were 60.8 and 50.6%, respectively. In conclusion, the results indicate that upfront HDT/ASCT in patients with high‑risk DLBCL is feasible and may improve the outcome of these patients. It may be beneficial for patients to undergo HDT/ASCT as an early treatment, prior to the development of therapy resistance.

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1	A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. 329:987–994. 1993. View Article : Google Scholar : PubMed/NCBI
2	Ziepert M, Hasenclever D, Kuhnt E, Glass B, Schmitz N, Pfreundschuh M and Loeffler M: Standard international prognostic index remains a valid predictor of outcome for patients with aggressive CD20+ B-cell lymphoma in the rituximab era. J Clin Oncol. 28:2373–2380. 2010. View Article : Google Scholar : PubMed/NCBI
3	Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, Klasa R, Savage KJ, Shenkier T, Sutherland J, et al: The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood. 109:1857–1861. 2007. View Article : Google Scholar : PubMed/NCBI
4	Vitolo U, Chiappella A, Brusamolino E, et al: A randomized multicenter phase III study for first line treatment of young patients with high risk (AAIPI 2–3) diffuse large B-cell lymphoma (DLBCL): Rituximab (R) plus dose-dense chemotherapy CHOP14/MEGA CHOP14 with or without intensified high-dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT). Results of DLCL04 trial of Italian lymphoma foundation (FIL). Ann Oncol. 22:1062011.
5	Schmitz N, Nickelsen M, Ziepert M, Haenel M, Borchmann P, Schmidt C, Viardot A, Bentez N, Peter N, Ehninger G, et al: Conventional chemoimmunotherapy (R-CHOEP)-14 or high-dose therapy (R-Mega-CHOEP) for young, high-risk patients with aggressive B-cell lymphoma: Final results of the randomized Mega-CHOEP trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). J Clin Oncol. 29:80022011. View Article : Google Scholar
6	Stiff PJ, Unger JM, Cook J, Constine S, Couban S, Shea TC, Winter JN, Miller TP, Tubbs RR, Marcellus DC, et al: Randomized phase III U.S./Canadian intergroup trial (Swog S9704) comparing CHOP (+/−) R for eight cycles to CHOP (+/−) R for six cycles followed by autotransplantation for patients with high-intermediate (H-int) or high IPI grade diffuse aggressive non-Hodgkin lymphoma (NHL). J Clin Oncol. 29:80012011. View Article : Google Scholar
7	Le Gouill S, Milpied NJ, Lamy T, Delwail V, Gressin R, Guyotat D, Damaj GL, Foussard C, Cartron G, Maisonneuve H, et al: First-line rituximab (R) high-dose therapy (R-HDT) versus R-CHOP14 for young adults with diffuse large B-Cell lymphoma: Preliminary results of the GOELAMS 075 prospective multicenter randomized trial. J Clin Oncol. 29:80032011. View Article : Google Scholar
8	Stiff PJ, Unger JM, Cook JR, Constine LS, Couban S, Stewart DA, Shea TC, Porcu P, Winter JN, Kahl BS, et al: Autologous transplantation as consolidation for aggressive non-Hodgkin's lymphoma. N Engl J Med. 369:1681–1690. 2013. View Article : Google Scholar : PubMed/NCBI
9	The Ministry of Health, Labor and Welfare, . Ethical Guidelines for Medical and Health Research Involving Human Subjects. http://www.mhlw.go.jp/file/06-Seisakujouhou-10600000-Daijinkanboukouseikagakuka/0000080278.pdf
10	http://www.kmu.ac.jp/hirakata/visit/treatment/medical_section/ketuekishuyounaika.html
11	Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, Lister TA, Vose J, Grillo-López A, Hagenbeek A, et al: Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 17:12441999. View Article : Google Scholar : PubMed/NCBI
12	Kameoka Y, Takahashi N, Ishizawa K, Kato Y, Ito J, Sasaki O, Murai K, Noji H, Hirokawa M, Tajima K, et al: Safety and feasibility of high-dose ranimustine (MCNU), carboplatin, etoposide and cyclophosphamide (MCVC) therapy followed by autologous stem cell transplantation for malignant lymphoma. Int J Hematol. 96:624–630. 2012. View Article : Google Scholar : PubMed/NCBI
13	Kawabata K, Hagiwara S, Takenouchi A, Tanimura A, Tanuma J, Tachikawa N, Miwa A and Oka S: Autologous stem cell transplantation using MEAM regimen for relapsed AIDS-related lymphoma patients who received highly active anti-retroviral therapy: A report of three cases. Intern Med. 48:111–114. 2009. View Article : Google Scholar : PubMed/NCBI
14	NCCN Clinical Practice Guidelines in Oncology: Prevention and Treatment of Cancer-Related Infections. Version 1. 2017.https://www.nccn.org/professionals/physician_gls/f_guidelines.asp
15	Japanese Society of Hematology, . clinical practice guideline. http://www.jshem.or.jp/gui-hemali/table.html
16	Kanda Y: Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 48:452–458. 2013. View Article : Google Scholar : PubMed/NCBI
17	NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin's lymphomas. Version 2. 2016.https://www.nccn.org/professionals/physician_gls/f_guidelines.asp