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Abstract
To date, no clinical trial has addressed salvage therapy intensity for relapsed/refractory diffuse large B-cell lymphoma (DLBCL). We sought to determine whether the more intensive salvage chemotherapy approach used in Southern Alberta (SAB) compared to the conventional dose salvage approach used in Northern Alberta (NAB) affects the rates of autologous stem cell transplant (ASCT) and survival in patients with relapsed DLBCL. Using instrumental variable analysis, we examined 147 consecutive patients with relapsed/refractory DLBCL from 2004 to 2010 who received salvage therapy in SAB (n = 70) or NAB (n = 77). Patients treated in SAB had higher rates of: salvage chemotherapy response (85.0% vs. 54.0%, p = 0.001), ASCT (61.4% vs. 41.6%, p = 0.016) and 4-year overall survival (41% vs. 20%, p = 0.002) than those in NAB, respectively. This study supports the hypothesis that selective use of intensive salvage chemotherapy leads to higher rates of ASCT and survival in this population.
Acknowledgements
We wish to acknowledge members of the Alberta Hematology Tumor Team and Alberta Blood and Marrow Transplant Program for providing excellent patient care, and managers of the Alberta Lymphoma Database and Members of the Guideline Utilization Resource Unit for Alberta Health Services, CancerControl, who contributed to data collection for this study.
Potential conflict of interest:
Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.
This study was supported by a grant from the Alberta Cancer Foundation (ACF# 103 0713 7160002925). The Alberta Lymphoma Database was also funded in part by a grant from Hoffmann-La Roche, Canada.