Autologous Haematopoietic Stem Cell Transplantation Is a Highly Effective Second Line of Treatment for Patients with Diffuse Large B-Cell Lymphoma

Abstract 4519

Diffuse large B-cell lymphoma (DLBCL) remains one of the most frequently seen non-Hodgkin lymphoma (NHL) with an aggressive disease course. It estimates that only 40–50% of patients (pts) may be cured with chemo - and radiotherapy; the remaining pts subset remains partially chemosensitive or resistant. High dose chemotherapy (HDT) followed by autologous haematopoietic stem cell transplantation (AHSCT) is a method of choice for the pts who didn’t achieve complete remission (CR) after R-CHOP or CHOP treatment.

We present 80 pts with DLBCL (47 male and 33 female, with a median age of 52. (range 18–68 yrs) who were underwent AHSCT between January 1999 and April 2011 in our Department. Ann Arbor staging at diagnosis was as follows: II- (n=11), III- (n=17), IV- (n=32); 48 of pts manifested B-symptoms. 50 of pts had an aged-adjusted IPI 2 or 3, 8 pts - IPI 4. Clinical manifestation at diagnosis included: hepatomegaly (n=16), splenomegaly (n=19), enlargement of the lymph nodes (n=39), bone marrow infiltration (n=7), lung infiltrates (n=5), digestive system involvement (n=9), CNS (n=4), tonsils (n=3). Initially, all were treated CHOP but 65 of them received chemotherapy with rituximab and achieved partial response (PR) which was defined as the reduction of measurable disease by ≥50% without the appearance of any new lesions. Patients with PR proceeded to high dose chemotherapy (HDT) followed by AHSCT.

Stem cells were collected from peripheral blood after IVE chemotherapy (IVE – ifosfamide 3g/m2 iv in 1–3d, etoposide, epirubicine 50mg iv in1d) in 67 patients, in 9 with other treatment and subsequent administration of granulocyte-colony stimulating factor (G-CSF) at a dose of 10ug/kg/d, starting from +5 day of chemotherapy till the last day of collection. G-CSF alone (10ug/kg/d) was used in 4 remaining patients. Collections were performed using Optia Spectra. All patients collected the sufficient number of CD34+ cells for AHSCT procedure. Conditioning regimens preceeding AHSCT consisted of CBV in 73 cases, BEAM in 6 and LACE in one. A median number of transplanted CD34+ cells was 3,97 (1.25 – 35.76×10^6/kg). All patient successfully engrafted. Hematopoietic recovery was as following: WBC count > 1,0×10^9/L after median of 12 days (range 8–16 days),ANC> 0,5×10^9/L after median of 14 days (range 8–17 days) and platelet count >20×10^9/L after median of 14 days (range 7–21 days). None of pts die due to AHSCT (TRM 0%). The major complications after AHSCT were rare and included: bacterial infections of the respiratory tract (n=15), viral infections (n=10), oral mucositis (n=9). 145 months’ disease free survival (DSF) was estimated to be 88% with a 145 months’ overall survival of 86%.

69 patients achieved CR after AHSCT (86,3%). Six pts underwent second AHSCT and 4 of them achieved CR. At the last contact, 75 pts are alive with a median follow-up period of 56 months (range 3–145). 5 patients died due to disease progression.

HDT followed by AHSCT seems to be highly effective and safe procedure for DLBCL patients.