[Comment] High-dose chemotherapy and autologous stem-cell transplantation for DLBCL in the rituximab era

In this issue of The Lancet Oncology, Annalisa Chiappella and colleagues1 report the results of high-dose chemotherapy and autologous stem-cell transplantation as part of first-line treatment for young patients with diffuse large B-cell lymphoma with poor prognosis—patients with two or three risk factors according to the age-adjusted international prognostic index (aa-IPI). By use of a 2×2 factorial design, two questions were addressed: first, whether a dose-escalated version of a 14-day R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone) regimen, R-MegaCHOP-14, is better than R-CHOP-14; and second, whether results can be improved by switching patients in remission after four cycles of R-CHOP-14 or R-MegaCHOP-14 to a programme that includes an intensive consolidation regimen: MAD (cytarabine plus mitoxantrone plus dexamethasone), followed by high-dose chemotherapy and autologous stem-cell transplantation (transplantation group) rather than maintaining them on R-CHOP-14 or R-MegaCHOP-14 (no transplantation group).

http://ift.tt/2tEavNf