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Annals of Oncology 14:140-151, 2003
© 2003 European Society for Medical Oncology

Original Paper

High-dose therapy in diffuse large cell lymphoma: results and prognostic factors in 452 patients from the GEL-TAMO Spanish Cooperative Group

M. D. Caballero1,+, J. A. Pérez-Simón1, A. Iriondo2, J. J. Lahuerta3, J. Sierra4, J. Marín5, M. Gandarillas2, R. Arranz6, J. Zuazu7, V. Rubio8, A. Fernández de Sevilla9, E. Carreras10, J. García-Conde11, J. García-Laraña12, C. Grande13, A. Sureda14, M. J. Vidal5, J. Rifón15, C. Pérez-Equiza15, R. Varela16, J. M. Moraleda17, J. C. García Ruíz18, C. Albó19, R. Cabrera20, J. F. San Miguel1 and E. Conde On behalf of the Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea Spanish Cooperative Group2

1 Hospital Clínico Universitario, Salamanca; 2 Hospital Marqués de Valdecilla, Santander; 3 Hospital 12 de Octubre, Madrid; 4 Hospital de la Santa Creu i Sant Pau, Barcelona; 5 Hospital Ntra. Sra. De Aránzazu, San Sebastián; 6 Hospital de la Princesa, Madrid; 7 Hospital de la Vall de Hebrón, Barcelona; 8 Hospital de Jerez, Jerez de la Frontera; 9 Institut Català d’Oncologia, Hospital Duran i Reynals, Barcelona; 10 Hospital Clinic i Provincial, Barcelona; 11 Hospital Clínico Universitario, Valencia; 12 Hospital Ramón y Cajal, Madrid; 13 Hospital 12 de Octubre, Madrid; 14 Hospital de la Santa Creu i Sant Pau, Barcelona; 15 Clínica Universitaria de Navarra, Pamplona; 16 Hospital Juan Canalejo, La Coruña; 17 Hospital General Universitario, Murcia; 18 Hospital de Cruces, Bilbao; 19 Hospital Xeral i Cies, Vigo; 20 Hospital Puerta de Hierro, Madrid, Spain

Received 5 March 2002; revised 11 June 2002; accepted 17 July 2002

Background:

The purpose of this study was to analyse the results and prognostic factors influencing overall survival (OS) and disease-free survival (DFS) in 452 patients diagnosed with diffuse large cell lymphomas (DLCL) treated with high-dose therapy (HDT) included in the Grupo Español de Linfomas/Trasplante Autólogo de Médula Osea (GEL-TAMO) Spanish registry.

Patients and methods:

At transplantation, median age was 42 years (range 15–73), 146 patients (32%) were transplanted in first complete remission (1st CR), 19% in second CR (2nd CR) and 47% had active disease: sensitive disease in 157 (35%) patients [95 were in first partial remission (1st PR) and 62 in second PR (2nd PR)] and refractory disease in 55 (12%) patients. Age-adjusted International Prognostic Index (IPI) was 2 or 3 in 51 patients (12%). Conditioning regimen consisted of BEAM (carmustine, etoposide, cytarabine and melphalan) in 39% of patients, BEAC (carmustine, etoposide, cytarabine and cyclophosphamide) in 33%, CBV (carmustine, etoposide and cyclophosphamide) in 10% and cyclophosphamide plus total body irradiation (TBI) in 12%.

Results:

Estimated overall survival (OS) and disease-free survival (DFS) at 5 years were 53% and 43%, respectively. The transplant-related mortality was 11% (53 cases). By multivariate analysis three variables significantly influenced OS and DFS: number of protocols to reach 1st CR, disease status at transplant and TBI in the conditioning regimen. Age-adjusted IPI at transplantation also influenced OS.

Conclusions:

Prolonged OS and DFS can be achieved in patients with DLCL after HDT and our results suggest that the best line of chemotherapy should be used up-front in patients considered as candidates for HDT in order to obtain an early CR. Resistant patients are not good candidates for HDT and they should be offered newer strategies. Finally, polichemotherapy conditioning regimens offer better results compared with TBI.

Key words: autologous transplant, diffuse large cell lymphoma, high-dose therapy, prognostic factors


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