Pretreatment prognostic factors and outcome in patients with relapsed or primary-refractory diffuse large B-cell lymphoma treated with second-line chemotherapy and autologous stem cell transplantation.

The age-adjusted International Prognostic Index assessed before salvage therapy with ICE (ifosfamide, carboplatin, etoposide) predicts outcome in patients with relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL). Patients can be stratified according to this index into favorable and unfavorable cohorts. Subsequently we attempted to determine if the cell of origin as determined by immunohistochemistry would predict outcome, as it had in the first-line setting. However, none of the molecular markers, which are prognostic in first-line therapy, nor immunohistochemical classification by cell of origin, relate to survival outcome of DLBCL patients in the second-line setting, implying that dose intensification of therapy can overcome the prognostic import of these unfavourable risk factors.