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Futility of Relapsed Diffuse Large B Cell Lymphoma Transplantation?
Biology of Blood and Marrow Transplantation, In Press, Uncorrected Proof, Available online 1 September 2014
Before the era of rituximab, high-dose chemotherapy with autologous stem cell transplantation (ASCT) served as the standard of care for relapsed, aggressive diffuse large B cell lumphoma (DLBCL) that was chemosensitive to salvage chemotherapy. Dramatic improvement has been observed with the addition of rituximab to chemotherapy. Nevertheless, depending on clinical and biological prognostic factors, some patients will not be cured because they are refractory to first-line treatment or because they have relapsed. Could a different behavior be expected in relapsed disease because of the introduction of rituximab, thus questioning the place of auto-transplantation? The COllaborative trial in Relapsed Aggressive Lymphoma (CORAL) study was designed as an international effort to determine which salvage regimens should be proposed to patients with relapsed DLBCL and to evaluate the place of rituximab for maintenance after ASCT, but some of the conclusions were disappointing.