Journal
BRITISH JOURNAL OF HAEMATOLOGY
Volume 152, Issue 5, Pages 561-569Publisher
WILEY
DOI: 10.1111/j.1365-2141.2010.08549.x
Keywords
diffuse large B cell lymphoma; autologous stem cell transplantation; late effects; treatment-related mortality
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P>High dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the preferred treatment modality for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). To assess long-term outcomes of these patients, we retrospectively analysed data from 309 consecutive patients who underwent ASCT for DLBCL between 1994 and 2006. We found that non-relapse mortality (NRM) became the major cause of death beginning approximately 8 years after ASCT. The most common causes of NRM during the study period were respiratory failure (31%), infection (13%), cardiac toxicity (15%) and secondary malignancy (15%). The strongest predictor of relapse mortality (RM) was disease status at transplant: patients who were in second or greater complete or partial remission had a higher risk of RM than those in first complete or partial remission [hazard ratio (HR) 3 center dot 7, P < 0 center dot 001], as did those who were relapsed or refractory (HR 4 center dot 9, P < 0 center dot 001). We describe the longest reported follow-up of a large cohort of DLBCL patients uniformly-treated with ASCT. Although relapse was initially the more likely cause of death, NRM exceeded RM after 8 years. After ASCT, surviving patients have significantly increased risk mortality rates relative to the general population and this excess risk persists over time.
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