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Controlled Clinical Trial
. 2023 Apr;6(4):e1786.
doi: 10.1002/cnr2.1786. Epub 2023 Feb 28.

The significance of upfront autologous stem cell transplantation for high-intermediate/high-risk stage IV diffuse large B-cell lymphoma

Aleksei K Koviazin  1   2 , Larisa V Filatova  1   2   3 , Ilia S Zyuzgin  1 , Anna S Artemyeva  4 , Ilia L Poliatskin  4 , Darya S Burda  4 , Stanislav A Volchenkov  1 , Svetlana S Elkhova  1 , Tatiana Yu Semiglazova  2   3
Affiliations
Controlled Clinical Trial

The significance of upfront autologous stem cell transplantation for high-intermediate/high-risk stage IV diffuse large B-cell lymphoma

Aleksei K Koviazin et al. Cancer Rep (Hoboken). 2023 Apr.

Abstract

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common (30%-35%) type of B-cell lymphoma. Only about 60% of all newly diagnosed advanced-stage DLBCL can be completely treated with x6 R-CHOP. High-dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation in the first remission (upfront auto-HSCT) can serve as an option to improve a prognosis in these patients.

Aims: This trial aimed to improve prognosis in DLBCL by upfront auto-HSCT.

Methods and results: A group of 105 patients: DLBCL NOS, age 18-65, stage IV, IPI ≥2, CR/PR after x6 R-CHOP/DA-EPOCH-R from 2010 to 2019 at NMRC of Oncology named after N.N.Petrov of MoH of Russia was retrospectively analyzed. The HSCT group included patients with upfront HDCT followed by auto-HSCT (n = 35). The control group included patients with non-invasive follow-up after induction (n = 70). Primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), response rate and relapse rate. The 3-year OS (p = .013) and 3-year PFS (p = .033) were significantly higher in the HSCT group. The 3-year OS was decreased by the occurrence of relapse (p ≤ .001) and weight loss (B-symptom) (p = .04). DEL was the negative prognostic factor for 3-year PFS in all patients (p = .001) and control group (p = .001). DA-EPOCH-R significantly increased the 3-year PFS (p = .041).

Conclusion: Upfront HDCT followed by auto-HSCT can increase 3-year OS and PFS and improve prognosis in DLBCL NOS, age 18-65, stage IV, IPI ≥2 patients.

Keywords: autologous hematopoietic stem cell transplantation; diffuse large B-cell lymphoma; high-risk; stage IV.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

FIGURE 1
FIGURE 1
Study design.
FIGURE 2
FIGURE 2
Clinical response in upfront group. Inner ring—response after ICT. Outer ring—response after upfront HDCT with auto‐HSCT.
FIGURE 3
FIGURE 3
Between‐group comparisons. Inner ring–upfront group, n = 35. Outer ring—control group, n = 70. (A) Relapse rate; (B) Outcome.
FIGURE 4
FIGURE 4
Progression‐free survival results. (A) PFS by treatment groups. (B) PFS by DEL. (C) PFS by lung involvement. (D) PFS by ICT.
FIGURE 5
FIGURE 5
Overall survival results. (A) OS by treatment groups; (B) OS by relapse occurrence.
See this image and copyright information in PMC

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