Clinical Research Papers:
Prognostic analysis of DLBCL patients and the role of upfront ASCT in highintermediate and highrisk patients
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Ying Zhao1,*, Hong Wang1,3,4,*, Song Jin1,*, Jiajia Zheng1, Man Huang1, Yaqiong Tang1, Zhengming Jin1,2,3,4, Huiying Qiu1,2,3,4, Xiaowen Tang1,2,3,4, Chengcheng Fu1,2,3,4, Yue Han1,2,3,4 and De-Pei Wu1,2,3,4
1Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
2Collaborative Innovation Center of Hematology of Soochow University, Suzhou, China
3Institute of Blood and Marrow Transplantation, Suzhou, China
4Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
*These authors have contributed equally to this work
Correspondence to:
Yue Han, email: [email protected]
De-Pei Wu, email: [email protected]
Keywords: diffuse large B-cell lymphoma, autologous stem cell transplantation, international prognostic index (IPI), germinal center B cell, non-germinal center B cell
Received: January 25, 2017 Accepted: March 30, 2017 Published: April 21, 2017
ABSTRACT
The role of autologous stem cell transplantation (ASCT) as a frontline treatment in patients with diffuse large B cell lymphoma (DLBCL) who are in their first remission has not been fully elucidated in the rituximab era. We analyzed 272 DLBCL patients who received 4–6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) or R-CHOP followed by ASCT, from January 2005 to June 2013 in our institution. Multivariate analysis showed the none germinal center B cell (non-GCB) subtype (P=0.014, P=0.012) and International Prognostic Index (IPI) (3–5) (P=0.004, P=0.016) were independent unfavorable predictors of overall survival (OS) and progression-free survival (PFS), respectively. To investigate the treatment effect of upfront ASCT, we selected 94 high-intermediate and high-risk DLBCL patients who achieved complete remission after R-CHOP, with 41 in the ASCT and 53 in the non-ASCT groups. Survival analysis revealed patients who received upfront ASCT compared with those who did not had better OS (3-year OS: 74.5% vs. 50.4%, P=0.029) or PFS (3-year PFS: 59.6% vs. 32.1%, P=0.004), suggesting up-front ASCT following R-CHOP could improve the outcome of high-intermediate and high-risk DLBCL patients.