Consolidation of high-dose chemotherapy with transplantation of autologous hematopoietic stem cells of the first remission of diffuse large B-cell lymphoma


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Abstract

The standard treatment for diffuse large B-cell lymphoma (DLBCL) is R-CHOP immunochemotherapy. About 60% of patients are completely cured by 1st-line therapy; primary-resistant forms account for about 15%, recurrence of the disease with the highest frequency in the first two years after diagnosis occurs in 25% of patients. Treatment outcomes for high-risk DLBCL (aalPI) patients are suboptimal. The search to achieve complete long-term remission during 1st-line therapy continues. The advantage of high-dose chemotherapy (HDCT) with autologous hematopoietic stem cell transplantation (auto-HSCT) in 1st-line treatment of DLBCL remains controversial. A meta-analysis of randomized and retrospective trials revealed only short-term improvement in survival with 1st-line HDCT with auto-HSCT in patients with high intermediate and high risk DLBCL. The benefits of HDCT with auto-HSCT in terms of long-term survival were noted only in retrospective studies in achieving a complete response (PET-CT) after induction chemotherapy (CT). Early consolidation of HDCT with auto-HSCT in patients with high-risk DLBCL, taking into account only clinical factors, does not lead to an improvement in survival and increases the risk of grade 3-4 adverse events. Identification of clinical, morphological and genetic factors of the effectiveness of anticancer therapy and prognosis will make it possible to determine the optimal strategy for DLBCL therapy. Further prospective studies of predictive and prognostic factors to identify patients in whom early consolidation of HDCT with auto-HSCT of the first complete remission may become the optimal method of choosing therapy are required.

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About the authors

A. K Kovyazin

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

L. V Filatova

N.N. Petrov National Medical Research Center of Oncology; North-Western State Medical University n.a. I.I. Mechnikov

Email: larisa_filatova@list.ru
St. Petersburg, Russia

I. S Zyuzgin

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

M. S Motalkina

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

Yu. A Chudinovskikh

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

E. V Cherkasova

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

S. A Volchenkov

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

S. A Shalaev

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

I. V Ishmatova

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

A. A Zverkova

N.N. Petrov National Medical Research Center of Oncology

St. Petersburg, Russia

T. Yu Semiglazova

N.N. Petrov National Medical Research Center of Oncology; North-Western State Medical University n.a. I.I. Mechnikov

St. Petersburg, Russia

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