large b cell lymphoma survival rate | High dose chemotherapy with autograft of stem cells in the first line treatment of aggressive form of lymphoma non-Hodgkin (NHL) in adults

High dose chemotherapy with autograft of stem cells in the first line treatment of aggressive form of lymphoma non-Hodgkin (NHL) in adults



The aggressive non-hodgkiniens (NHL) lymphomas are forms of lymphoma to rapid growth. The most common type is the diffuse Lymphoma large cell B (DLBCL) but there are several other aggressive lymphoma subtypes and variants of diffuse large cell B, including the centroblastique, the immunoblastosarcome Lymphoma Lymphoma or the anaplastic Lymphoma large cell B. Aggressive non-hodgkiniens lymphoma are usually sensitive to conventional cancer treatments such as chemotherapy and radiotherapy. In the 1980s, a large number of researchers have reported that some patients with diffuse Lymphoma large cell, who had not responded to conventional chemotherapy, could be cured by a high dose chemotherapy and a autologous transplant of stem cells or bone marrow transplant. These techniques can be used to treat cancer, because the high doses of chemotherapy can destroy the bone marrow of the patient. This is why it is samples of stem cells or bone marrow on the patient before treatment. Bone marrow or stem cells are then frozen and the patient receives chemotherapy to high dose with or without radiation therapy to treat cancer. Bone marrow or stem cells that have been collected are then thawed and introduced using a needle into a vein to replace the marrow that was destroyed. This type of transplant is called autologous transplant. If introduced marrow is taken from another person, the transplant is an allogeneic transplant. During the first decade of studies on the autologous for aggressive lymphoma treatment, the focus has been on the application of this approach to save patients after a relapse or if the disease had already progressed under a standard chemotherapy. These encouraging results concerning the progressive Lymphoma or recurrent led to tests of the technique to the title of primary treatment for the disease. However, it was also important to identify the factors likely to predict the outcome of treatment in patients with aggressive lymphoma. The IPI (international Prognostic Index) score was established in 1993. This score has been developed to better predict the evolution of aggressive lymphoma. To after the number of negative prognostic factors present at diagnosis (age > 60 years, disease in stages III/IV, rate high lactodeshydrogenase [LDH], > 2 ECOG performance index (Eastern Cooperative Oncology Group), with several disease) extra-ganglionnaires sites), four groups of results (low-risk, low-intermediate risk, risk high-intermediate and high risk) have been identified with an overall survival over 5 years ranging from 26% to 73%.

Over the last few years, several randomized trials on chemotherapy high doses with autologous in patients with aggressive lymphoma have been reported. These studies have included the incorporation of autograft in the initial treatment, the use of an autologous transplant adjuvant in patients with complete response, and the use of this approach to treatment in patients who had a slow response or incomplete in their original plan of chemotherapy. In these trials, contradictory results of high dose chemotherapy with autograft as a first line treatment have been reported. Some studies have indicated a trend towards better survival in patients with a poor prognosis according to the IPI (international Prognostic Index) adapted to the age score, while others have failed to show any advantage for the first of high dose chemotherapy. We therefore conducted this systematic review with meta-analysis to assess the effects of such aggressive treatment on overall survival in patients with non-Hodgkin lymphoma.

The main results of this analysis are the following:
(i) in General, there is no evidence that the high dose chemotherapy improves overall survival (SG) (HR 1.05; CI 0.92 to 1.19) or (EFS) event-free survival (HR 0.92;) IC 0.80 in 1,05).
(ii) in patients with a good score risk aaIPI (IPI score adapted to the age), there is some evidence of an increase in overall survival (HR 1.46 (SG); CI 1.02 to 2.09) if they had been treated by high-dose chemotherapy.
(iii) on the other hand, there was evidence suggesting but only confirming that patients with a low risk score could benefit from the high dose chemotherapy.

Overall, compared to the large population included in our analyses and the attempts in order to minimize biases and confounding factors, we conclude that there is no evidence of a general benefit of the therapeutic principle of the myeloablative chemotherapy followed of an autologous transplant of stem cells for patients with aggressive non-Hodgkin (NHL) Lymphoma as a treatment of first line according to the data available to us at present.

We found improvements in complete remission and relapse-free survival rates, but they are not translated into beneficial effect on overall survival (WIS) in the respective groups.

But more important still, it seems that the high dose in the treatment of first-line chemotherapy is harmful in patients with an IPI score at low risk: patients. In addition, thanks to the availability of the antibody monoclonal anti-CD20, Rituximab, patients with a good risk score will have a better overall result after a conventional immunochimiotherapie combined. However, if the high dose chemotherapy is used in patients at high risk, there may be a beneficial effect, but doctors should not arbitrarily use chemotherapy to high dose during the first-line treatment. There is an urgent need to deal with this group of high-risk patients in trials on a large scale with procedures and harmonized definitions, which would facilitate the comparability of the results, and would improve the evaluation of the intervention therapeutic. Additional research should be either reproduction of the studies showing positive trends either enforcement new approaches that do not exclusively rely on the principle of chemotherapy to high dose with registry autologous.

The authors conclusions:.

Despite higher rates of complete response, there is no beneficial effect of the high dose chemotherapy with autograft of stem cells as first line treatment in patients with lymphoma non-Hodgkin (NHL) aggressive.