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Original Article

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Blood Res 2014; 49(2):

Published online June 25, 2014

https://doi.org/10.5045/br.2014.49.2.107

© The Korean Society of Hematology

R-CHOP chemoimmunotherapy followed by autologous transplantation for the treatment of diffuse large B-cell lymphoma

Hong Ghi Lee1*, Yunsuk Choi1, Sung-Yong Kim1, Inho Kim2, Yeo-Kyeoung Kim3, Yang Soo Kim4, Ho Sup Lee4, Seok Jin Kim5, Jeong-A Kim6, Byeong-Bae Park7, Jinny Park8, Hyeok Shim9, Hyeon Seok Eom10, Junglim Lee11, Sung Kyu Park12, June-Won Cheong13, and Keon Woo Park14

Author Info. +

1Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

3Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.

4Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea.

5Department of Medicine, Samsung Medical Center, Seoul, Korea.

6Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea.

7Department of Internal Medicine, Hanyang University, Seoul, Korea.

8Department of Internal Medicine, Gachon University, Incheon, Korea.

9Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea.

10Department of Internal Medicine, National Cancer Center, Ilsan, Korea.

11Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea.

12Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea.

13Department of Internal Medicine, Yonsei University, Seoul, Korea.

14Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea.

Correspondence to : Correspondence to Hong Ghi Lee, M.D., Ph.D. Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. Tel: +82-2-2030-7538, Fax: +82-2-2030-7458, mlee@kuh.ac.kr

Received: March 1, 2014; Revised: March 26, 2014; Accepted: May 15, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background

We investigated factors that influence outcomes in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab combined with the CHOP regimen (R-CHOP) followed by upfront autologous stem cell transplantation (Auto-SCT).

Methods

We retrospectively evaluated survival differences between subgroups based on the age-adjusted International Prognostic Index (aaIPI) and revised-IPI (R-IPI) at diagnosis, disease status, and positron emission tomographic/computerized tomographic (PET/CT) status at transplantation in 51 CD20-positive DLBCL patients treated with R-CHOP followed by upfront Auto-SCT.

Results

Patients had either stage I/II bulky disease (5.9%) or stage III/IV disease (94.1%). The median patient age at diagnosis was 47 years (range, 22-66 years); 53.3% and 26.7% had high-intermediate and high risks according to aaIPI, respectively. At the time of Auto-SCT, 72.5% and 27.5% experienced complete (CR) and partial remission (PR) after R-CHOP, respectively. The median time from diagnosis to Auto-SCT was 7.27 months (range, 3.4-13.4 months). The 5-year overall (OS) and progression-free survival (PFS) were 77.3% and 72.4%, respectively. The 5-year OS and PFS rates according to aaIPI, R-IPI, and PET/CT status did not differ between the subgroups. More importantly, the 5-year OS and PFS rates of the patients who achieved PR at the time of Auto-SCT were not inferior to those of the patients who achieved CR (P=0.223 and 0.292, respectively).

Conclusion

Survival was not influenced by the aaIPI and R-IPI at diagnosis, disease status, or PET/CT status at transplantation, suggesting that upfront Auto-SCT might overcome unfavorable outcomes attributed to PR after induction chemoimmunotherapy.

Keywords Diffuse large B-cell lymphoma, Hematopoietic stem cell transplantation, Autologous transplantation, Rituximab, Survival analysis

Article

Original Article

Blood Res 2014; 49(2): 107-114

Published online June 25, 2014 https://doi.org/10.5045/br.2014.49.2.107

Copyright © The Korean Society of Hematology.

R-CHOP chemoimmunotherapy followed by autologous transplantation for the treatment of diffuse large B-cell lymphoma

Hong Ghi Lee1*, Yunsuk Choi1, Sung-Yong Kim1, Inho Kim2, Yeo-Kyeoung Kim3, Yang Soo Kim4, Ho Sup Lee4, Seok Jin Kim5, Jeong-A Kim6, Byeong-Bae Park7, Jinny Park8, Hyeok Shim9, Hyeon Seok Eom10, Junglim Lee11, Sung Kyu Park12, June-Won Cheong13, and Keon Woo Park14

1Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea.

2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.

3Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.

4Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea.

5Department of Medicine, Samsung Medical Center, Seoul, Korea.

6Department of Internal Medicine, the Catholic University of Korea, Seoul, Korea.

7Department of Internal Medicine, Hanyang University, Seoul, Korea.

8Department of Internal Medicine, Gachon University, Incheon, Korea.

9Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea.

10Department of Internal Medicine, National Cancer Center, Ilsan, Korea.

11Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea.

12Department of Internal Medicine, Soonchunhyang University Hospital, Bucheon, Korea.

13Department of Internal Medicine, Yonsei University, Seoul, Korea.

14Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea.

Correspondence to: Correspondence to Hong Ghi Lee, M.D., Ph.D. Division of Hematology-Oncology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. Tel: +82-2-2030-7538, Fax: +82-2-2030-7458, mlee@kuh.ac.kr

Received: March 1, 2014; Revised: March 26, 2014; Accepted: May 15, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

We investigated factors that influence outcomes in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab combined with the CHOP regimen (R-CHOP) followed by upfront autologous stem cell transplantation (Auto-SCT).

Methods

We retrospectively evaluated survival differences between subgroups based on the age-adjusted International Prognostic Index (aaIPI) and revised-IPI (R-IPI) at diagnosis, disease status, and positron emission tomographic/computerized tomographic (PET/CT) status at transplantation in 51 CD20-positive DLBCL patients treated with R-CHOP followed by upfront Auto-SCT.

Results

Patients had either stage I/II bulky disease (5.9%) or stage III/IV disease (94.1%). The median patient age at diagnosis was 47 years (range, 22-66 years); 53.3% and 26.7% had high-intermediate and high risks according to aaIPI, respectively. At the time of Auto-SCT, 72.5% and 27.5% experienced complete (CR) and partial remission (PR) after R-CHOP, respectively. The median time from diagnosis to Auto-SCT was 7.27 months (range, 3.4-13.4 months). The 5-year overall (OS) and progression-free survival (PFS) were 77.3% and 72.4%, respectively. The 5-year OS and PFS rates according to aaIPI, R-IPI, and PET/CT status did not differ between the subgroups. More importantly, the 5-year OS and PFS rates of the patients who achieved PR at the time of Auto-SCT were not inferior to those of the patients who achieved CR (P=0.223 and 0.292, respectively).

Conclusion

Survival was not influenced by the aaIPI and R-IPI at diagnosis, disease status, or PET/CT status at transplantation, suggesting that upfront Auto-SCT might overcome unfavorable outcomes attributed to PR after induction chemoimmunotherapy.

Keywords: Diffuse large B-cell lymphoma, Hematopoietic stem cell transplantation, Autologous transplantation, Rituximab, Survival analysis

Fig 1.

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Figure 1.

(A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) for 51 diffuse large B-cell lymphoma (DLBCL) patients. (B) Probability of progression-free survival after Auto-SCT for 51 DLBCL patients.

Blood Research 2014; 49: 107-114https://doi.org/10.5045/br.2014.49.2.107

Fig 2.

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Figure 2.

(A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the age-adjusted International Prognostic Index (aaIPI) score at diagnosis. (B) Probability of progression-free survival after Auto-SCT according to the aaIPI score at diagnosis.

Blood Research 2014; 49: 107-114https://doi.org/10.5045/br.2014.49.2.107

Fig 3.

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Figure 3.

(A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the revised International Prognostic Index (IPI) score at diagnosis. (B) Probability of progression-free survival after Auto-SCT according to the revised IPI score at diagnosis.

Blood Research 2014; 49: 107-114https://doi.org/10.5045/br.2014.49.2.107

Fig 4.

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Figure 4.

(A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the disease status at transplantation. (B) Probability of progression-free survival after Auto-SCT according to the disease status at transplantation.

Blood Research 2014; 49: 107-114https://doi.org/10.5045/br.2014.49.2.107

Fig 5.

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Figure 5.

(A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the disease status at transplantation for patients classified into the age-adjusted International Prognostic Index (aaIPI) high-intermediate- and high-risk groups. (B) Probability of progression-free survival after Auto-SCT according to the disease status after transplantation for patients classified into the aaIPI high-intermediate and high-risk groups.

Blood Research 2014; 49: 107-114https://doi.org/10.5045/br.2014.49.2.107

Fig 6.

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Figure 6.

(A) Probability of overall survival after autologous stem cell transplantation (Auto-SCT) according to the 18F-fluoro-2-deoxy-D-glucose positron emission tomographic/computed tomographic (FDG PET/CT) status at transplantation. (B) Probability of progression-free survival after Auto-SCT according to the FDG PET/CT status at transplantation.

Blood Research 2014; 49: 107-114https://doi.org/10.5045/br.2014.49.2.107

Table 1 . Patient and disease characteristics at diagnosis..

a)B symptoms indicate systemic symptoms such as fever, night sweats, and weight loss, which are associated with non-Hodgkin's lymphoma..

Abbreviations: LDH, lactate dehydrogenase; BM, bone marrow; ECOG, Eastern Cooperative Oncology Group; PS, performance status; IPI, International Prognostic Index..

Table 2 . Treatments before ASCT and transplantation characteristics..

Abbreviations: ASCT, autologous stem cell transplantation; RCHOP, rituximab+cyclophosphamide+adriamycin+vincristine+prednisolone; CR, complete remission; PR, partial remission; RT, radiation therapy; SCT, stem cell transplantation; FDG, 18F-fluoro-2-deoxy-D-glucose; PET, positron emission tomography; CT, computed tomography; G-CSF, granulocyte colony-stimulating factor; BU, busulfan; CY, cyclophosphamide; VP-16, etoposide; MEL, melphalan; Mito, mitoxantrone; ARAC, cytosine arabinoside; BCNU, carmustine; Ifos, ifosfamide; Carb, carboplatine; CD, cluster of differentiation; ANC, absolute neutrophil count; PLT, platelet..
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