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Annals of Oncology 2004 15(10):1504-1509; doi:10.1093/annonc/mdh391
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© 2004 European Society for Medical Oncology

Original Article

Autologous stem-cell transplantation in diffuse large B-cell non-Hodgkin's lymphoma not achieving complete response after induction chemotherapy: the GEL/TAMO experience

J. Rodriguez1,*, M. D. Caballero2, A. Gutierrez1, C. Solano3, R. Arranz4, J. J. Lahuerta5, J. Sierra6, M. Gandarillas7, J. A. Perez-Simon2, J. Zuazu8, A. Lopez-Guillermo9, A. Sureda6, E. Carreras9, J. Garcia-Laraña10, J. Marin11, J. C. Garcia12, A. Fernandez de Sevilla13, J. Rifon14, R. Varela15, I. Jarque16, C. Albo17, A. Leon18, J. SanMiguel2 and E. Conde7 On behalf of the GEL/TAMO Spanish Group

1 Hospital Son Dureta, Palma de Mallorca; 2 Hospital Clinico Universitario, Salamanca; 3 Hospital Clínico Universitario de Valencia; 4 Hospital de la Princesa, Madrid; 5 Hospital 12 de Octubre, Madrid; 6 Hospital de la Santa Creu i Sant Pau, Barcelona; 7 Hospital Marques de Valdecilla, Santander; 8 Hospital de la Vall de Hebron, Barcelona; 9 Hospital Clinic i Provincial, Barcelona; 10 Hospital Ramon y Cajal, Madrid; 11 Hospital Nuestra Señora de Aranzazu, San Sebastian; 12 Hospital de Cruces, Vizcaya; 13 Institut Catala d'Oncologia, Barcelona; 14 Clinica Universitaria de Navarra, Pamplona; 15 Hospital Juan Canalejo, La Coruña; 16 Hospital La Fe, Valencia; 17 Hospital Xeral i Cies, Vigo; 18 Hospital General de Jerez, Jerez de la Frontera, Spain

* Correspondence to: Dr J. Rodriguez, Servicio de Oncología, Hospital Son Dureta, Av/Andrea Doria, 47, Palma de Mallorca 07014, Spain. Tel: +34-971-175000 ext. 75934; Fax: +34-971-175500; Email: jrodriguez{at}hsd.es

Background: Here we evaluate the results of high-dose chemotherapy and autologous stem-cell transplantation (HDC/ASCT) in 114 patients included in the GEL/TAMO registry between January 1990 and December 1999 with diffuse large B-cell lymphoma who failed to achieve complete remission (CR) with front-line conventional chemotherapy.

Patients and methods: Sixty-eight per cent had a partial response (PR) and 32% failed to respond to front-line therapy. At transplant, 35% were chemoresistant and 29% had two to three adjusted International Prognostic Index (a-IPI) risk factors.

Results: After HDC/ASCT, 57 (54%) of 105 patients evaluable for response achieved a CR, 16 (15%) a PR and 32 (30%) failed. Nine patients were not assessed for response because of early death due to toxicity. With a median follow-up of 29 months for alive patients, the survival at 5 years is 43%, with a disease-free survival for complete responders of 63%. The lethal toxicity was 8%. Multivariate analysis revealed a-IPI and chemoresistance to be predicting factors.

Conclusions: Our results show that one-third of patients who do not obtain a CR to front-line chemotherapy may be cured of their disease with HDC/ASCT. However, most chemoresistant patients pretransplant failed this therapy. For this population, as well as for those who presented with adverse factors of the a-IPI, pretransplant novel therapeutic modalities need to be tested.

Key words: autologous stem-cell transplantation, diffuse large B-cell, non-Hodgkin's lymphoma


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