BACKGROUND, The current study was conducted to analyze the outcome and prog
nostic factors of patients with diffuse large B-cell lymphoma (DLCL) who di
d not achieve a complete response (CR) to first-line treatment.
METHODS, The current study was comprised of 83 patients (43 males and 40 fe
males with a median age of 62 years) who did not achieve a CR (58 of whom h
ad primary refractory disease and 25 of whom achieved a partial response) w
ith initial treatment (doxorubicin-containing regimens in 87% of cases) fro
m a series of 239 patients consecutively diagnosed with DLCL at a single in
stitution. Initial variables, response to therapy, and salvage treatment we
re analyzed to predict survival.
RESULTS, Compared with patients who achieved a CR, nonresponders or partial
responders more frequently were of advanced age and had a poor performance
status (PS), B-symptoms, advanced stage of disease, bone marrow infiltrati
on, increased serum lactate dehydrogenase, and a high-risk International Pr
ognostic Index. Among the 58 patients with primary refractory disease, 18 d
ied during initial treatment due to toxicity (14 patients) or disease progr
ession (4 patients). The main variables predicting early death were a poor
PS, age > 60 years, and an immunoblastic DLCL subtype. Twenty-five of these
58 patients were able to receive salvage regimens, with only 1 of them ach
ieving a CR. The median survival for this group of patients was 10 months.
With regard to those patients achieving a partial response, 18 of the 25 pa
tients received further therapy with 28% of them achieving a CR. The median
survival was 23 months. The degree of the response was found to be the onl
y significant variable with which to predict survival, with 2-year survival
rates of 4% and 40%, respectively, for patients with primary refractory di
sease and patients who achieved a partial response.
CONCLUSIONS. The prognosis of patients with primarily refractory DLCL is ex
tremely unfavorable, whereas that of patients who achieve a partial respons
e is slightly better. The inclusion of these patients in experimental trial
s is limited due to their tendency to be of an older age and to have a poor
general status. Cancer 2001;91:1557-62. (C) 2001 American Cancer Society.