A retrospective analysis of 144 patients with aggressive non-Hodgkin's lymphoma: impact of autologous stem cell transplantation in first remission onoutcome

Background and Objectives. To analyze the impact of a sequential program in cluding autologous stem cell transplantation in first remission on the outc ome of patients with aggressive non-Hodgkin's lymphoma. Design and Methods. Patients aged less than 60 years old, with an aggressiv e non-Hodgkin's lymphoma and at least a partial response after first line t herapy (chemotherapy +/- radiotherapy) were included in the study. Results. One hundred and forty-four patients were registered: of them 126 r eached at least a partial response after first line therapy and 71 ( 56.5%) were then submitted to autologous stem cell transplantation. The overall s urvival (OS) and progression-free survival (PFS) of the whole population we re respectively 70% and 63% at a median follow-up from diagnosis of 51 mont hs (7-115). The PFS of the transplanted group was 93% at a median follow-up from diagnosis of 54 months (20-155); the PFS of the nontransplanted patie nts was 43.5% at a median followup from diagnosis of 30 months (8-109) (p < 0.0001). Interpretation and Conclusions. The two groups (transplanted vs not transpl anted patients in remission after induction therapy) were homogeneous conce rning the major risk factors (stage III-IV - p = 0.26; performance status - p = 0.25; B-symptoms - p = 0.3; LDH level - = 0.4; extranodal disease - p = 0.4; bulky disease p = 0.7): so we compared them in order to discover cli nical features at diagnosis which adversely affected PFS. In a multivariate analysis, factors which adversely affected PFS were: LDH level - p = 0.03; number of extranodal sites - p = 0.04; not performing the transplant - p = 0.02. When patients were stratified by number of extranodal sites and by L DH level, only the transplant being performed retained its positive influen ce - p = 0.04. (C) 2000, Ferrata Storti Foundation.