Journal of Clinical Oncology, Vol 16, 63-69, Copyright © 1998 by American Society of Clinical Oncology
High-dose chemotherapy for relapsed and refractory diffuse large B-cell lymphoma: mediastinal localization predicts for a favorable outcome
U Popat, D Przepiork, R Champlin, W Pugh, K Amin, R Mehra, J Rodriguez, S Giralt, J Romaguera, A Rodriguez, A Preti, B Andersson, I Khouri, D Claxton, M de Lima, M Donato, P Anderlini, J Gajewski, F Cabanillas and K van Besien
Department of Hematology, MD Anderson Cancer Center, Houston, TX, USA.
PURPOSE: This study was performed to evaluate the outcome of high-dose
chemotherapy and autologous transplantation in patients with diffuse B-
cell large-cell lymphoma, and, specifically, to evaluate the impact of
primary mediastinal localization on the outcome of high-dose chemotherapy.
PATIENTS AND METHODS: A retrospective review was performed of all patients
with diffuse large B-cell lymphoma who underwent autologous marrow or
peripheral-blood stem-cell transplantation at our institution between
January 1 986 and December 1995. RESULTS: Ninety patients were identified,
of whom 31 (34%) had a primary mediastinal B-cell large-cell lymphoma
(PML). Cumulative probabilities of disease-free survival, overall survival,
and disease progression are 40% (95% confidence interval [CI], 29 to 51),
42% (95% CI, 31 to 53), and 52% (95% CI, 40 to 64), respectively. By
univariate analysis, low lactate dehydrogenase (LDH) level and low Ann
Arbor stage at transplant were associated with improved survival and
disease-free survival. There was a trend for improved disease-free survival
and survival for patients with PML. Multivariate stepwise Cox regression
analysis showed that LDH level, Ann Arbor stage, and primary mediastinal
localization were independent favorable prognostic factors for disease-free
survival and survival. LDH level and Ann Arbor stage were also predictive
for the risk of disease progression. CONCLUSION: Our results indicate that
patients with PML may display an increased susceptibility to high-dose
chemotherapy compared with other types of B- cell large-cell lymphoma.
These findings, if confirmed, may have implications for the initial
management of patients with PML.
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