Upfront High-Dose Chemotherapy Followed by Auto-HSCT Improved Prognosis Among Patients With High-Intermediate/High-Risk Stage IV DLBCL

Results from a Retrospective Cohort Trial

According to findings from a retrospective cohort single-center study, high-dose chemotherapy (HDCT) followed by autologous hematopoietic stem-cell transplantation (allo-HSCT) in the first remission yielded effective results and improved prognosis among patients with intermediate/high-risk stage IV diffuse large B-cell lymphoma (DLBCL) not otherwise specified (NOS). The authors noted that this regimen is still under investigation, and will require additional trials.

According to Aleksei K Koviazin, MD, National Medical Research Center of Oncology, Saint-Petersburg, Russian Federation, and coauthors, although 85% of patients achieve complete responses from standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) immunotherapy for DLBCL, “about 25% will relapse [...] [and] half of the relapsed will not be candidates for high-dose chemotherapy with autologous stem cell transplantation, which is the second-line standard of treatment in this case.” 

The study authors aimed to assess the efficacy of upfront auto-HSCT in the first remission after HDCT. The primary endpoint was progression-free survival (PFS), and secondary endpoints included overall survival, response rate, and relapse rate. 

The retrospective study included 105 patients with stage IV DLBCL NOS and high International Prognostic Index (IPI) scores who had undergone R-CHOP or dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) treatment and achieved complete or partial responses were enrolled in this trial and randomized into 2 cohorts. The upfront arm included patients (n = 35) who underwent upfront HDCT followed by auto-HSCT, and the control arm included patients (n = 70) without consolidation after induction chemotherapy. 

In this analysis, the OS (p = .013) and PFS (p = .033) at 3 years were significantly higher in the HSCT group than in the control group. Study authors noted that the 3-year OS was decreased by incidences of relapse (p ≤ .001) and weight loss (B-symptom) (p = .04). Double-expressor lymphoma (DEL) status was a negative prognostic factor for progression-free survival among all patients. Additionally, DA-EPOCH-R significantly increased progression-free survival.

Dr Koviazin et al concluded, “Upfront HDCT followed by auto-HSCT can increase 3-year [overall survival] (OS) and progression-free survival (PFS) and improve prognosis in DLBCL NOS,” and stated that, “Upfront auto-HSCT can serve as a familiar and adequate option to significantly improve a prognosis in young high-risk patients with DEL DLBCL.” 

The study authors also noted several limitations of this trial, adding, “the upfront auto-HSCT is still under investigation. Further trials are needed to better select the target group of this treatment option.”

Source: 

Koviazin AK, Filatova LV, Zyuzgin IS, et al. The significance of upfront autologous stem cell transplantation for high-intermediate/high-risk stage IV diffuse large B-cell lymphoma. Cancer Rep (Hoboken). 2023;6(4):e1786. doi:10.1002/cnr2.1786