Autologous transplantation for diffuse aggressive non-Hodgkin's lymphoma in patients never achieving remission: A report from the Autologous Blood and Marrow Transplant Registry

Purpose: To evaluate the results of high-dose chemotherapy and autologous h ematopoietic stem-cell transplantation (autotransplants) in patients with d iffuse aggressive non-Hodgkin's lymphoma (NHL) who never achieve a complete remission with conventional chemotherapy, Patients and Methods: Detailed records from the Autologous Blood and Marrow Transplant Registry (AB-MTR) on 184 patients with diffuse aggressive NHL w ho never achieved a complete remission with conventional chemotherapy and s ubsequently received an autotransplant were evaluated, Transplants were per formed between 1989 and 1995 and were reported to the ABMTR by 48 centers i n North and South America. Results: Seventy-nine (44%) of 184 patients achieved a complete remission o r ct complete remission with residual imaging abnormalities of unknown sign ificance after autotransplantation. Thirty-four(19%) of 184 had a partial r emission and 55 (31%) of 184 had no response or progressive disease. Eleven patients (6%) were not assessable for response because of early death. The probabilities of progression-free and overall survival at 5 years after tr ansplantation were 31% (95% confidence interval [CI], 24% ta 38%) and 37% ( 95% CI, 30% to 45%), respectively. In multivariate analysis, chemotherapy r esistance, Karnofsky performance status score less than 80 at transplantati on, age greater than or equal to 55 years at transplantation, receiving thr ee or more prior chemotherapy regimens, and not receiving pre- or posttrans plant involved-field irradiation therapy were adverse prognostic factors fo r overall survival. Conclusion: High-dose chemotherapy and autologous hematopoietic stem-cell t ransplantation should be considered for patients with diffuse aggressive NH L who never achieve a complete remission but who are still chemotherapy-sen sitive and are otherwise transplant candidates. J Clin Oncol 19:406-413. (C ) 2001 by American Society of Clinical Oncology.