Prognostic factors in patients with relapsed or refractory diffuse large B-cell lymphoma who underwent autologous stem-cell transplantation

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 It is still unclear what factors are associated with a poor prognosis after ASCT for relapsed or refractory diffuse large B-cell lymphoma (DLBCL). The study cohort included 43 patients with relapsed or refractory DLBCL who underwent ASCT. Biopsy specimens were immunohistochemically analyzed for CD10, BCL6, MUM1, BCL2, and MYC. Thirty-seven patients (86%) received rituximab before ASCT, and the age-adjusted International Prognostic Index (aaIPI) at relapse was 2-3 in 18 patients (42%). Immunohistochemical analysis showed that 88% of samples were of the non-GCB type, and concurrent expression of BCL2 and MYC was observed in 59% of samples at diagnosis. The probability of 3-year overall survival (OS) was 65%. The poor prognostic factors for OS were aaIPI 2-3 at relapse (hazard ratio [HR], 4.1; 95% confidence interval [CI], 1.4-12.4) and no rituximab before ASCT (HR, 6.6; 95%CI, 2.1-20.9). The 3-year relapse incidence was 43%, and 2 factors were also significant risk factors for relapse (high aaIPI: HR, 3.0; 95%CI, 1.1-7.9 and no rituximab before ASCT: HR, 9.2; 95%CI, 3.6-23.3). In the rituximab era, novel treatment strategies might be required in DLBCL patients with high aaIPI at relapse.