Upfront autologous stem cell transplantation treatment for patients with high-risk diffuse large B-cell lymphoma

This study looked at the effectiveness of autologous stem cell transplantation after their first remission for patients with high-risk diffuse large B-cell lymphoma. The study concluded that patients who received autologous stem cell transplantation had better outcomes than those who did not.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. First-line treatment for DLBCL is R-CHOP chemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). Autologous stem cell transplantation (auto-SCT; using stem cells from the patient’s own body) is used as second line therapy.

Auto-SCT is considered very effective. However auto-SCT is most often used later in a patient’s treatment strategy. More research is needed to determine the effectiveness of auto-SCT after first remission. 

The medical records of 272 patients were reviewed. 208 patients were treated with R-CHOP alone. 64 patients were treated with R-CHOP followed by auto-SCT. The average length of follow up was 37 months.

The progression free survival rate (time from treatment to disease progression) was better for patients who received auto-SCT than those who did not. The difference was not statistically significant.

94 patients had high-risk DLBCL. All of these patients achieved a complete response (no detectable cancer) after R-CHOP therapy. 41 of these high risk patients received auto-SCT. 53 patients did not. Of the high-risk patients, patients who had auto-SCT treatment had significantly better 3-year progressive free survival rates (59.6%) compared to patients who did not receive auto-SCT (32.1%). Patients treated with auto-SCT also had significantly better 3-year overall survival rates (time from treatment to death from any cause) (74.5%) compared to patients who did not receive auto-SCT (50.4%). 

The authors concluded that patients with high-risk diffuse large B-cell lymphoma have better outcomes when treated with R-CHOP followed by autologous stem cell transplantation compared to R-CHOP alone.