Yoon Jae-Ho, Kim Jong-Wook, Jeon Young-Woo, Lee Sung-Eun, Eom Ki-Seong, Kim Yoo-Jin, Lee Seok, Kim Hee-Je, Min Chang-Ki, Lee Jong-Wook, Min Woo-Sung, Park Chong-Won, Cho Seok-Goo
Department of Hematology, Catholic Blood and Marrow Transplantation Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Intern Med. 2015 May;30(3):362-71. doi: 10.3904/kjim.2015.30.3.362. Epub 2015 Apr 29.
BACKGROUND/AIMS: Several studies have demonstrated the effect of autologous hematopoietic stem cell transplantation (auto-HSCT) as a salvage treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL). However, the role of auto-HSCT as a frontline treatment has not been fully investigated in the rituximab era. We validated the age-adjusted International Prognostic Index (aaIPI) score for high-risk DLBCL patients and identified a possible role for frontline auto-HSCT.
We recommended frontline auto-HSCT for high-risk DLBCL patients who satisfied the criteria of both a higher Ann-Arbor stage (III to IV) and an elevated lactate dehydrogenase (LDH) level at diagnosis with an aaIPI score ≥ 2. From 2006 to 2011, among the 150 DLBCL patients aged ≤ 60 years who were treated with six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), 23 high-risk patients with a complete response (CR) were treated with auto-HSCT. For comparison, we selected 35 well-matched high-risk patients with CR who completed R-CHOP treatment alone. In addition, there were 81 low-risk patients and 11 refractory patients.
DLBCL patients with an aaIPI score ≥ 2 showed inferior overall survival (OS; p = 0.040) and progression-free survival (PFS; p = 0.007) compared to the aaIPI score 0 to 1. Between the two treatment arms among the high-risk DLBCL patients, the clinical parameters were not different. The high-risk group treated with frontline auto-HSCT showed similar OS (p = 0.392) and PFS (p = 0.670) to those in the low-risk group. Thus, frontline auto-HSCT showed superior PFS (p = 0.004), but only a trend towards favorable OS (p = 0.091) compared to R-CHOP alone.
We identified the possible role of frontline auto-HSCT for high-risk DLBCL with a higher stage (III to IV) and elevated LDH level.
背景/目的：多项研究已证实自体造血干细胞移植（auto-HSCT）作为复发弥漫性大B细胞淋巴瘤（DLBCL）患者挽救治疗的效果。然而，在利妥昔单抗时代，auto-HSCT作为一线治疗的作用尚未得到充分研究。我们验证了高危DLBCL患者的年龄校正国际预后指数（aaIPI）评分，并确定了一线auto-HSCT的可能作用。
我们建议对符合较高Ann-Arbor分期（III至IV期）且诊断时乳酸脱氢酶（LDH）水平升高且aaIPI评分≥2标准的高危DLBCL患者进行一线auto-HSCT。2006年至2011年期间，在150例接受6周期利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗的年龄≤60岁的DLBCL患者中，23例完全缓解（CR）的高危患者接受了auto-HSCT治疗。为作比较，我们选择了35例匹配良好的CR高危患者，他们仅完成了R-CHOP治疗。此外，有81例低危患者和11例难治性患者。
与aaIPI评分为0至1的患者相比，aaIPI评分≥2的DLBCL患者总生存期（OS；p = 0.040）和无进展生存期（PFS；p = 0.007）较差。在高危DLBCL患者的两个治疗组之间，临床参数无差异。接受一线auto-HSCT治疗的高危组与低危组的OS（p = 0.392）和PFS（p = 0.670）相似。因此，与单纯R-CHOP相比，一线auto-HSCT显示出更好的PFS（p = 0.004），但OS仅呈有利趋势（p = 0.091）。
我们确定了一线auto-HSCT对于分期较高（III至IV期）且LDH水平升高的高危DLBCL的可能作用。
