Researchers identified prognostic factors among patients who underwent autologous stem cell transplantation (ASCT) for relapsed or high-risk diffuse large B-cell lymphoma (DLBCL) before and after the time periods where rituximab therapy was introduced in a study published in the International Journal of Hematology.
The researchers evaluated registry data from the Japan Society for Hematopoietic Cell Transplantation database to determine outcomes among patients with relapsed or high-risk DLBCL and to highlight any differences between the prerituximab era in Japan (1990-2001) and the era after rituximab was introduced (2002-2007). Factors affecting patient survival were also compared.
In total, data from 1222 patients were included. Median patient age was 55 years (range, 16-79); 697 patients (57%) were male; 565 patients (46%) were more than 55 years old when they underwent ASCT; 1122 patients (92%) had a performance status of 0 or 1 at ASCT; 93 patients (8%) had a performance status of 2 to 4; 1069 patients (87%) underwent ASCT between 2002 and 2007; and 153 patients (13%) underwent ASCT between 1990 and 2001.
Median follow-up was 22 months; the 2-year overall survival (OS) and progression-free survival (PFS) rates were 71% and 68%, respectively. The overall 2-year nonrelapse mortality (NRM) rate was 6%, and the 2-year relapse or progression rate was 26%.
Disease status at ASCT was found to be predictive of both NRM (P =.005) and relapse or progression (P <.001). Being older than 55 years (P <.001) and having a worse performance status (P <.001) were both predictive of worse NRM but not relapse or progression. Undergoing ASCT in the prerituximab era (P <.001) was predictive of relapse or progression but not NRM.
“Because upfront ASCT for newly diagnosed high-risk DLBCL has not been performed recently, registry database studies to assess the impact of ASCT for relapsed or refractory de novo DLBCL and transformed indolent lymphoma in the rituximab era are warranted,” the researchers wrote.
1. Kim SW, Asakura Y, Tajima K, et al. High-dose therapy and autologous stem cell transplantation for relapsed or high-risk diffuse large B-cell lymphoma: a nationwide survey. Int J Hematol. 2020;111:256-266. doi:10.1007/s12185-019-02772-1