What is the role of HDC-ASCS in the treatment of relapsed/refractory DLBCL?

Updated: Jun 12, 2019
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The role of HDC-ASCS in the treatment of relapsed/refractory DLBCL was confirmed by the only international randomized phase III clinical trial known as the PARMA study. [111] In this particular study, patients with relapsed/refractory DLBCL underwent salvage chemotherapy for 2 cycles. Patients with chemotherapy-sensitive DLBCL were randomized to further salvage chemotherapy with cytarabine/platinum-based chemotherapy alone or in combination with ASCS. The results of this study demonstrated that event-free survival (EFS) and overall survival (OS) at 5 years in the transplant arm were 46% and 53%, respectively, compared with 12% and 32% in the chemotherapy alone arm.

Moreover, subset analysis for the patients revealed that response to salvage chemotherapy was associated with a 5-year progression-free survival (PFS) rate of 43%, in contrast to a 1-year OS rate of 22% for patients with chemotherapy-resistant disease. [111] Based on these results, salvage chemotherapy followed by HDC-ASCS has been adopted as the standard of care for transplant-eligible DLBCL patients.

Subsequent work was focused on the development of tools to predict which patients were most likely to benefit from HDC-ASCS, such as the value of age-adjusted the International Prognostic Index (IPI) score or positron emission tomography (PET) scanning after salvage chemotherapy. [112, 113, 114]


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