High-Dose Therapy and Autologous Stem Cell Transplantation in First Relapse for Diffuse Large B Cell Lymphoma in the Rituximab Era: An Analysis Based on Data from the European Blood and Marrow Transplantation Registry

for the Lymphoma Working Party of the European Blood and Marrow Transplantation Registry (EBMT)

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Autologous stem cell transplantation (ASCT) consolidation remains the treatment of choice for patients with relapsed diffuse large B cell lymphoma. The impact of rituximab combined with chemotherapy in either first- or second-line therapy on the ultimate results of ASCT remains to be determined, however. This study was designed to evaluate the benefit of ASCT in patients achieving a second complete remission after salvage chemotherapy by retrospectively comparing the disease-free survival (DFS) after ASCT for each patient with the duration of the first complete remission (CR1). Between 1990 and 2005, a total of 470 patients who had undergone ASCT and reported to the European Blood and Bone Transplantation Registry with Medical Essential Data Form B information were evaluated. Of these 470 patients, 351 (74%) had not received rituximab before ASCT, and 119 (25%) had received rituximab before ASCT. The median duration of CR1 was 11 months. The median time from diagnosis to ASCT was 24 months. The BEAM protocol was the most frequently used conditioning regimen (67%). After ASCT, the 5-year overall survival was 63% (95% confidence interval, 58%-67%) and 5-year DFS was 48% (95% confidence interval, 43%-53%) for the entire patient population. Statistical analysis showed a significant increase in DFS after ASCT compared with duration of CR1 (median, 51 months versus 11 months; P <.001). This difference was also highly significant for patients with previous exposure to rituximab (median, 10 months versus not reached; P <.001) and for patients who had experienced relapse before 1 year (median, 6 months versus 47 months; P <.001). Our data indicate that ASCT can significantly increase DFS compared with the duration of CR1 in relapsed diffuse large B cell lymphoma and can alter the disease course even in patients with high-risk disease previously treated with rituximab.

Original languageEnglish
Pages (from-to)788-793
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number5
DOIs
Publication statusPublished - May 1 2012

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Lymphoma, Large B-Cell, Diffuse
Stem Cell Transplantation
Registries
Transplantation
Bone Marrow
Recurrence
Disease-Free Survival
Therapeutics
Rituximab
Confidence Intervals
Drug Therapy
Bone Transplantation

Keywords

  • Aggressive B cell lymphoma
  • Anti CD20 monoclonal antibody
  • Stem cell transplantation

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

High-Dose Therapy and Autologous Stem Cell Transplantation in First Relapse for Diffuse Large B Cell Lymphoma in the Rituximab Era : An Analysis Based on Data from the European Blood and Marrow Transplantation Registry. / for the Lymphoma Working Party of the European Blood and Marrow Transplantation Registry (EBMT).

In: Biology of Blood and Marrow Transplantation, Vol. 18, No. 5, 01.05.2012, p. 788-793.

Research output: Contribution to journalArticle

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abstract = "Autologous stem cell transplantation (ASCT) consolidation remains the treatment of choice for patients with relapsed diffuse large B cell lymphoma. The impact of rituximab combined with chemotherapy in either first- or second-line therapy on the ultimate results of ASCT remains to be determined, however. This study was designed to evaluate the benefit of ASCT in patients achieving a second complete remission after salvage chemotherapy by retrospectively comparing the disease-free survival (DFS) after ASCT for each patient with the duration of the first complete remission (CR1). Between 1990 and 2005, a total of 470 patients who had undergone ASCT and reported to the European Blood and Bone Transplantation Registry with Medical Essential Data Form B information were evaluated. Of these 470 patients, 351 (74{\%}) had not received rituximab before ASCT, and 119 (25{\%}) had received rituximab before ASCT. The median duration of CR1 was 11 months. The median time from diagnosis to ASCT was 24 months. The BEAM protocol was the most frequently used conditioning regimen (67{\%}). After ASCT, the 5-year overall survival was 63{\%} (95{\%} confidence interval, 58{\%}-67{\%}) and 5-year DFS was 48{\%} (95{\%} confidence interval, 43{\%}-53{\%}) for the entire patient population. Statistical analysis showed a significant increase in DFS after ASCT compared with duration of CR1 (median, 51 months versus 11 months; P <.001). This difference was also highly significant for patients with previous exposure to rituximab (median, 10 months versus not reached; P <.001) and for patients who had experienced relapse before 1 year (median, 6 months versus 47 months; P <.001). Our data indicate that ASCT can significantly increase DFS compared with the duration of CR1 in relapsed diffuse large B cell lymphoma and can alter the disease course even in patients with high-risk disease previously treated with rituximab.",
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T2 - An Analysis Based on Data from the European Blood and Marrow Transplantation Registry

AU - for the Lymphoma Working Party of the European Blood and Marrow Transplantation Registry (EBMT)

AU - Mounier, Nicolas

AU - Canals, Carmen

AU - Gisselbrecht, Christian

AU - Cornelissen, Jan

AU - Foa, Roberto

AU - Conde, Eulogio

AU - Maertens, John

AU - Attal, Michel

AU - Rambaldi, Alessandro

AU - Crawley, Charles

AU - Luan, Jian Jian

AU - Brune, Mats

AU - Wittnebel, Sebastian

AU - Cook, Gordon

AU - van Imhoff, G. W.

AU - Pfreundschuh, Michael

AU - Sureda, Anna

AU - Castagna, L.

AU - Russell, N. H.

AU - Colombat, P.

AU - Richardson, D.

AU - Polreicht, D.

AU - Tilly, H.

AU - Sutton, L.

AU - Carreras, E.

AU - Blaise, D.

AU - McQuaker, G.

AU - Peniket, A.

AU - Gramatzki, M.

AU - Milpied, N.

AU - Cortelazzo, S.

AU - Bosi, A.

AU - Irrera, G.

AU - Janssen, J.

AU - Passweg, J.

AU - Bacigalupo, A.

AU - Schattenberg, A.

AU - Mohty, M.

AU - Cortelezzi, A.

AU - Bay, J. O.

AU - Lenhoff, S.

AU - Volin, L.

AU - Cassuto, J. P.

AU - Duarte, R. F.

AU - Gribben, J.

AU - Michieli, M.

AU - Veelken, J. H.

AU - Poire, X.

AU - Petersen, E.

AU - Masszi, T.

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AB - Autologous stem cell transplantation (ASCT) consolidation remains the treatment of choice for patients with relapsed diffuse large B cell lymphoma. The impact of rituximab combined with chemotherapy in either first- or second-line therapy on the ultimate results of ASCT remains to be determined, however. This study was designed to evaluate the benefit of ASCT in patients achieving a second complete remission after salvage chemotherapy by retrospectively comparing the disease-free survival (DFS) after ASCT for each patient with the duration of the first complete remission (CR1). Between 1990 and 2005, a total of 470 patients who had undergone ASCT and reported to the European Blood and Bone Transplantation Registry with Medical Essential Data Form B information were evaluated. Of these 470 patients, 351 (74%) had not received rituximab before ASCT, and 119 (25%) had received rituximab before ASCT. The median duration of CR1 was 11 months. The median time from diagnosis to ASCT was 24 months. The BEAM protocol was the most frequently used conditioning regimen (67%). After ASCT, the 5-year overall survival was 63% (95% confidence interval, 58%-67%) and 5-year DFS was 48% (95% confidence interval, 43%-53%) for the entire patient population. Statistical analysis showed a significant increase in DFS after ASCT compared with duration of CR1 (median, 51 months versus 11 months; P <.001). This difference was also highly significant for patients with previous exposure to rituximab (median, 10 months versus not reached; P <.001) and for patients who had experienced relapse before 1 year (median, 6 months versus 47 months; P <.001). Our data indicate that ASCT can significantly increase DFS compared with the duration of CR1 in relapsed diffuse large B cell lymphoma and can alter the disease course even in patients with high-risk disease previously treated with rituximab.

KW - Aggressive B cell lymphoma

KW - Anti CD20 monoclonal antibody

KW - Stem cell transplantation

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