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Oncotarget. 2017 Apr 21;8(42):73168-73176. doi: 10.18632/oncotarget.17324. eCollection 2017 Sep 22.

Prognostic analysis of DLBCL patients and the role of upfront ASCT in high-intermediate and high-risk patients.

Zhao Y#1, Wang H#1,2,3, Jin S#1, Zheng J1, Huang M1, Tang Y1, Jin Z1,4,2,3, Qiu H1,4,2,3, Tang X1,4,2,3, Fu C1,4,2,3, Han Y1,4,2,3, Wu DP1,4,2,3.

Author information

1
Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
2
Institute of Blood and Marrow Transplantation, Suzhou, China.
3
Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China.
4
Collaborative Innovation Center of Hematology of Soochow University, Suzhou, China.
#
Contributed equally

Abstract

The role of autologous stem cell transplantation (ASCT) as a frontline treatment in patients with diffuse large B cell lymphoma (DLBCL) who are in their first remission has not been fully elucidated in the rituximab era. We analyzed 272 DLBCL patients who received 4-6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) or R-CHOP followed by ASCT, from January 2005 to June 2013 in our institution. Multivariate analysis showed the none germinal center B cell (non-GCB) subtype (P=0.014, P=0.012) and International Prognostic Index (IPI) (3-5) (P=0.004, P=0.016) were independent unfavorable predictors of overall survival (OS) and progression-free survival (PFS), respectively. To investigate the treatment effect of upfront ASCT, we selected 94 high-intermediate and high-risk DLBCL patients who achieved complete remission after R-CHOP, with 41 in the ASCT and 53 in the non-ASCT groups. Survival analysis revealed patients who received upfront ASCT compared with those who did not had better OS (3-year OS: 74.5% vs. 50.4%, P=0.029) or PFS (3-year PFS: 59.6% vs. 32.1%, P=0.004), suggesting up-front ASCT following R-CHOP could improve the outcome of high-intermediate and high-risk DLBCL patients.

KEYWORDS:

autologous stem cell transplantation; diffuse large B-cell lymphoma; germinal center B cell; international prognostic index (IPI); non-germinal center B cell

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