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Primary Diffuse Large B-Cell Lymphoma of the Mediastinum: Outcome
Following High-Dose Chemotherapy and Autologous Hematopoietic Cell
Transplantation
Laurie H. Sehn,
Joseph H. Antin,
Lawrence N. Shulman,
Peter Mauch,
Anthony Elias,
Marshall E. Kadin, and
Catherine Wheeler
From the Hematology-Oncology Division, Brigham and Women's Hospital;
Hematology-Oncology Division and Department of Pathology, Beth Israel
Hospital; Joint Center for Radiation Therapy, Division of Medical
Oncology, Dana-Farber Cancer Institute; and Harvard Medical School,
Boston, MA.
We performed a retrospective analysis of 35 patients with primary
diffuse large B-cell lymphoma of the mediastinum treated with high-dose
cyclophosphamide, carmustine, and etoposide (CBV) plus autologous
hematopoietic cell transplantation to determine outcome and prognostic
features for progression-free survival (PFS). Thirty-five patients with
primary diffuse large B-cell lymphoma of the mediastinum in first
response (complete remission [CR] or partial remission [PR]) with
poor prognostic features, with primarily refractory disease, or with
relapsed disease following conventional chemotherapy, were treated with
CBV and autologous hematopoietic cell transplantation. PFS and overall
survival were assessed by the Kaplan-Meier method. Patient
characteristics before transplantation were examined by univariate
analysis using the log-rank test and by Cox's proportional hazards
regression analysis to determine predictors of PFS. Estimated 5-year
PFS varied significantly with patient disease status at
transplantation. Patients transplanted in first response had an
estimated 5-year PFS rate of 83%, compared with 58% and 27% for
primarily refractory and relapsed patients, respectively
(P = .02). The strongest predictor of PFS was chemotherapy responsiveness immediately before transplantation. Patients with chemotherapy-responsive disease had a significantly greater PFS rate
than patients with chemotherapy-nonresponsive disease (risk ratio,
3.60; 95% confidence interval [CI], 1.14 to 11.4). No other factors
were found to be significant on univariate or multivariate analysis.
Patients with primary diffuse large B-cell lymphoma of the mediastinum
can achieve prolonged PFS following high-dose chemotherapy and
autologous hematopoietic cell transplantation. Outcomes are strongly
correlated with disease status (first response v refractory
v relapsed) at transplantation and chemotherapy responsiveness immediately before transplantation.
Blood, Vol. 91 No. 2 (January 15), 1998:
pp. 717-723
© 1998 by The American Society of Hematology.
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