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The non‐relapse mortality rate for patients with diffuse large B‐cell lymphoma is greater than relapse mortality 8 years after autologous stem cell transplantation and is significantly higher than mortality rates of population controls
Author(s) -
Hill Brian T.,
Rybicki Lisa,
Bolwell Brian J.,
Smith Stephen,
Dean Robert,
Kalaycio Matt,
Pohlman Brad,
Tench Shawnda,
Sobecks Ronald,
Andresen Steven,
Copelan Edward,
Sweetenham John
Publication year - 2011
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2010.08549.x
Subject(s) - medicine , autologous stem cell transplantation , hazard ratio , population , transplantation , diffuse large b cell lymphoma , lymphoma , surgery , refractory (planetary science) , cohort , oncology , confidence interval , physics , environmental health , astrobiology
Summary 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) 3·7, P < 0·001], as did those who were relapsed or refractory (HR 4·9, P < 0·001). 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.