HIGH-DOSE CHEMOTHERAPY FOR RELAPSED AND REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA - MEDIASTINAL LOCALIZATION PREDICTS FOR A FAVORABLE OUTCOME

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 chemot herapy. Patients and Methods: A retrospective review war performed of all patients with diffuse large B-cell lymphoma who underwent autologo us marrow or peripheral-blood stem-cell transplantation at our institu tion between January 1986 and December 1995. Results: Ninety patients were identified, of whom 31 (34%) had a primary mediastinal B-cell lar ge-cell lymphoma (PML). Cumulative probabilities of disease-free survi val, 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 dehydrogena se (LDH) level and low Ann Arbor stage at transplant were associated w ith improved survival and disease-free survival. There was a trend for improved disease-free survival and survival for patients with PML. Mu ltivariate stepwise Cox regression analysis showed that LDH level, Ann Arbor stage, and primary mediastinal localization were independent fa vorable prognostic factors For disease-free survival and survival. LDH level and Ann Arbor stage were also predictive for the risk of diseas e progression. Conclusion: Our results indicate that patients with PML may display an increased susceptibility to high-dose chemotherapy com pared with other types of B-cell large-cell lymphoma. These findings, if confirmed, may have implications for the initial management of pati ents with PML. (C) 1998 by American Society of Clinical Oncology.