Autologous Stem Cell Transplantation as Front Line Therapy Does Not Improve the Outcome of High Risk Aggressive Non-Hodgkin'S Lymphoma: A Single Center Study

The role of high dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) as front-line therapy in the high risk aggressive non-Hodgkin's lymphoma (NHL) patients is still a matter of debate, but several studies demonstrated the efficacy of HDT. Since Rituximab added to CHOP chemotherapy, OS and PFS were significantly improved. Therefore, we analysed to compare conventional chemotherapy with HDT followed by ASCT in aggressive NHL. We retrospectively reviewed the medical records of 357 patients with primary diagnosed aggressive NHL from January 2002 to December 2009. Among them, we select patients who achieved to complete or partial remission after first induction chemotherapy or had ≥ 3 International Prognostic Index (IPI) scores or stage III, IV. Among 357 patients, 42 patients younger than 65 years were enrolled and categorized to two groups: conventional chemotherapy group (n = 33, 79%) and HDT followed by ASTC group (n = 9, 21%). The median age at the time of diagnosis was 46 years (range, 15-64). Diffuse large B-Cell lymphoma (DLBLC, 48%), T-cell lymphoma (38%), lymphoblastic lymphoma (7%) was included. The proportion of Rituximab including regimen for induction chemotherapy were 49%. The five-year overall survival rate was not significantly different between two groups (72% in chemotherapy group vs. 70% in HDT group, P = 0.73). And the estimated progression free survival at five years was not significantly different between two groups (51% in chemotherapy group vs. 53% in HDT group, P = 0.63). The efficacy of HDT followed by ASTC during first-line treatment in patients with aggressive NHL does not improve the outcome and should be evaluated in randomized trials.