Late Relapses After High-dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Diffuse Large B-cell Lymphoma in the Rituximab Era |
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| Institution: | 1. Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, CA;2. Division of Epidemiology, Department of Public Health Sciences, University of Rochester, Rochester, NY;3. Department of Medicine, Yale New Haven Medical Center, New Haven, CT;4. Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY;5. Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY;6. Department of Radiation Oncology, James P. Wilmot Cancer Institute, University of Rochester, Rochester, NY;1. Department of Medicine, Massachusetts General Hospital, Boston, MA;2. Memorial University School of Medicine, St John''s, Newfoundland, Canada;3. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA;4. Center for Leukemia, Massachusetts General Hospital, Boston, MA;5. Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA;6. Center for Lymphoma, Massachusetts General Hospital, Boston, MA;7. Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA;8. Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA;1. Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Spain;2. Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Spain;1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and;2. Medical Oncology Division, Department of Medicine and;3. Department of Radiation Oncology, University of Washington, Seattle, WA;1. Unit of Lymphoid Malignancies, Department of Onco-Hematology, Milan, Italy;2. Vita-Salute San Raffaele University, Pathology Unit, Milan, Italy;3. San Raffaele Scientific Institute, Milan, Italy;4. Centro Trapianti e Terapie Cellulari “Carlo Melzi”, A O Universitaria S. Maria Misericordia, Udine, Italy;5. Division of Hematology, Spedali Civili, Brescia, Italy;6. Division of Medical Oncology, National Cancer Institute, Aviano, Italy;7. Division of Hematology, University Sapienza, Rome, Italy;8. Azienda Ospedaliera Università Senese, Siena, Italy;9. Division of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy;10. Division of Hematology, San Bortolo Hospital, Vicenza, Italy;11. Division of Hematology, Niguarda Hospital, Milan, Italy;12. Division of Hematology, Azienda Ospedaliera di Padua, University of Padua, Italy;13. Celgene, San Diego, CA, USA;14. Department of Oncology and Hematology; G. da Saliceto Hospital, Piacenza, Italy;15. U O di Oncologia ed Ematologia Oncologica, Ospedale di Mirano, Mirano, Italy;p. University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milano, Italy;1. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan;2. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan;3. Department of Cell Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan;4. Department of General Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, Japan;5. Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe, Japan |
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| Abstract: | BackgroundThe standard of care for diffuse large B-cell lymphoma (DLBCL) relapsing after front-line therapy is high-dose chemotherapy and autologous stem cell transplantation (ASCT). Evidence has suggested that early relapses (ie, within 1 year) after this approach portends exceptionally poor outcomes. However, data examining relapses > 1 year after ASCT for patients with refractory or relapsed DLBCL are limited, in particular, in the rituximab era. We sought to examine the effect of early (≤ 1 year) and late (> 1 year) relapse after ASCT in a single-institution cohort of patients with relapsed and refractory DLBCL treated with chemoimmunotherapy.Materials and MethodsA retrospective analysis was performed on the data from 85 consecutive patients who had undergone ASCT for biopsy-confirmed relapsed or refractory DLBCL from 2001 to 2010 at the University of Rochester Medical Center. All patients had received rituximab as a part of treatment. Of the 85 patients, 35 developed relapse after ASCT. These 35 patients were divided into 2 groups according to the timing of the relapse (≤ 1 year and > 1 year after ASCT).ResultsThe median follow-up period was 6.4 years. For all patients, the overall survival (OS) from post-ASCT relapse was 5.2 years. For the 27 patients developing relapse at ≤ 1 year after ASCT, the median OS was 0.6 year and progression-free survival was 0.4 year. For the 8 patients developing relapse at > 1 year after ASCT, the median OS was 5.9 years and progression-free survival was 2.9 years.ConclusionPatients with relapsed or refractory DLBCL experiencing relapse > 1 year after ASCT had good outcomes. Despite the relative rarity in incidence, a significant risk of relapse of DLBCL after ASCT remains, suggesting the need for continued monitoring because of the possibility of later progression. |
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| Keywords: | Autologous stem cell transplant DLBCL Early relapse Refractory Relapse |
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