Hematopoietic stem cell transplantation as salvage treatment in patients with aggresive non-Hodgkin's lymphoma

BACKGROUND: The indication of early hematopoietic stem cell transplantation (HSCT) in patients with aggressive non-Hodgkin's lymphoma (LNH) is controv ersial. PATIENTS AND METHODS: Retrospective analysis of 86 patients with aggressive NHL treated with MACOP/VACOP-B chemotherapy. HSCT was performed as salvage treatment to patients under 65 years of age with progressive disease or ch emosensitive relapse. Progression free survival (PFS) and overall survival (OS) were determined by the Kaplan-Meier method. Rates of response and surv ival functions were compared between the International Prognostic Index (IP I) groups using the Chi-square and log-rank tests, respectively. RESULTS: Patients median age was 48 years; 22% had T cell NHL and 57% had i ntermediate-high and high risk (high risk) IPI. There were 6 toxic deaths ( 7%), and treatment failure was observed in 42 patients (48.8%). Thirty one of them were candidates for TPH due to age under 65 years, although 21 were finally transplanted (including 13 with high risk IPI). A significant asso ciation between PFS and IPI was observed, 61.9% for low risk (low and low-i ntermediate) versus 28.2% for high risk groups (p = 0.0007). With a median follow up of 4.8 years, OS was 64%; 80.5% for low risk versus 52.6% for hig h risk IPI groups (p = 0.01), and 83.7% versus 62% for the same groups in p atients under 65 years of age (p = 0.02). The median follow up after failur e to chemotherapy was 42.7 months. CONCLUSIONS: In this retrospective study, OS rate in high risk IPI patients with NHL using HSCT as salvage treatment is similar to that reported using HSCT during earlier phases of treatment.