The significance of upfront autologous stem cell transplantation for high‐intermediate/high‐risk stage IV diffuse large B‐cell lymphoma

BACKGROUND: Diffuse large B‐cell lymphoma (DLBCL) is the most common (30%–35%) type of B‐cell lymphoma. Only about 60% of all newly diagnosed advanced‐stage DLBCL can be completely treated with x6 R‐CHOP. High‐dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation in the first remission (upfront auto‐HSCT) can serve as an option to improve a prognosis in these patients. AIMS: This trial aimed to improve prognosis in DLBCL by upfront auto‐HSCT. METHODS AND RESULTS: A group of 105 patients: DLBCL NOS, age 18–65, stage IV, IPI ≥2, CR/PR after x6 R‐CHOP/DA‐EPOCH‐R from 2010 to 2019 at NMRC of Oncology named after N.N.Petrov of MoH of Russia was retrospectively analyzed. The HSCT group included patients with upfront HDCT followed by auto‐HSCT (n = 35). The control group included patients with non‐invasive follow‐up after induction (n = 70). Primary endpoint was progression‐free survival (PFS). Secondary endpoints were overall survival (OS), response rate and relapse rate. The 3‐year OS (p = .013) and 3‐year PFS (p = .033) were significantly higher in the HSCT group. The 3‐year OS was decreased by the occurrence of relapse (p ≤ .001) and weight loss (B‐symptom) (p = .04). DEL was the negative prognostic factor for 3‐year PFS in all patients (p = .001) and control group (p = .001). DA‐EPOCH‐R significantly increased the 3‐year PFS (p = .041). CONCLUSION: Upfront HDCT followed by auto‐HSCT can increase 3‐year OS and PFS and improve prognosis in DLBCL NOS, age 18–65, stage IV, IPI ≥2 patients.