Evaluating high-dose etoposide before stem cell transplantation for patients with unresponsive diffuse large B cell lymphoma

This study evaluated the outcomes of patients with unresponsive diffuse B-cell lymphoma (DLBCL) after treatment with high-dose etoposide (Etopophos) and a stem cell transplant (SCT). This study concluded that this regimen was effective for some of these patients, namely those who responded to etoposide treatment.

DLBCL is one of the most common types of non-Hodgkin’s lymphoma. Typical first-line treatment involves chemoimmunotherapy. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is the most commonly used regimen. This treatment is effective in 60 – 70% of patients. Unfortunately, the cancer eventually returns or stops responding to further treatment in 30 – 40% of patients.

Autologous peripheral blood stem cell transplantation (autoPB-SCT) is another option for these patients. In this procedure, high-dose chemotherapy is given first to get rid of any remaining cancer cells. Then, healthy stem cells are collected from the patient’s bloodstream. These healthy cells are then reintroduced back to the patient. Whether patients with unresponsive DLBCL can benefit from this procedure is under investigation.

This study involved 40 patients with DLBCL that stopped responding to treatment with rituximab (Rituxan). All patients were treated with high-dose etoposide before undergoing SCT. Patients were followed-up for an average of 28.9 months.

Overall, 57.5% of patients responded to treatment with high-dose etoposide. During stem cell collection, 72.5% of patients developed infections but were successfully treated with antibiotics.

After the transplant, 42.5% of patients had a complete disappearance of all signs of cancer. 27.5% of patients had tumor shrinkage. 27.5% of patients had tumor growth or spread at an average of 28 days after the transplant. The average time to tumor growth or spread was on average 6.4 months after the transplant.

Overall, 49.3% of all patients were still alive 2 years later. This rate was significantly higher for patients who responded to treatment with high-dose etoposide compared to those who did not (77.7% vs. 11.8%). Response to etoposide treatment was significantly associated with an 81.7% lower mortality risk.

Overall, 44.7% of all patients were still alive 2 years later without tumor growth or spread. This rate was significantly higher for patients who responded to treatment with high-dose etoposide compared to those who did not (64.1% vs. 11.8%). Response to etoposide treatment was significantly associated with a 79% lower risk of tumor growth or spread.

This study concluded that high-dose etoposide followed by SCT was effective for some patients with unresponsive DLBCL. The authors suggest that etoposide treatment can help patients whose disease still responds to chemotherapy.

This was a small study. Larger studies are needed to confirm these results.