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Journal of Clinical Oncology, Vol 23, No 25 (September 1), 2005: pp. 6262 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.01.7814
In Reply:Emory University School of Medicine, Atlanta, GA
Washington University School of Medicine, Siteman Cancer Center, St Louis, MO In their letter, Akhtar and Maghfor diligently highlight important pitfalls related to retrospective database analyses. Most, if not all, points raised in their comments were already addressed in the Discussion section of our article.1 Indeed, far from drawing a cause-effect relationship, our article simply describes associations between the pretransplant administration of rituximab and outcomes of autologous stem-cell transplantation in a group of chemosensitive relapsed non-Hodgkin's lymphoma (primary induction failure and refractory relapses are not autografted at our center). This question is practically unanswerable in a prospective randomized trial, due to the increasing use of rituximab in non-Hodgkin's lymphoma patients. Figure 1 in the article summarizes trends in the administration of rituximab before referral to our center for autografting (including 2003 patients); however, only patients with at least 6 months of follow-up (transplantation before June 2003) were included in the analysis. Additionally, only commonly accepted prognostic indicators (age, time from diagnosis to relapse/transplant,2 number of prior chemotherapy regimens) with the exception of the IPI score at relapse3 (information not available in our database) were included in multivariate analyses. To our knowledge, neither pretransplantation therapy (induction4 or salvage) nor conditioning5 affects the outcomes of autografting for NHL. Finally, we agree with Akhtar and Maghfor that our article provides no explanation for the delay in platelets recovery in patients who received rituximab pretransplantation. As mentioned in the Results section, this observation is independent of age, time from diagnosis to transplantation, number of chemotherapy courses pretransplantation, number of CD34+ cells infused, and timing of administration of rituximab (< 3 or > 3 months). Interestingly, no significant bleeding was observed among our 273 transplantation patients, regardless of prior administration of rituximab, confirming the commonly accepted notion that bleeding after state-of-the-art autologous transplantation is a rather uncommon complication. Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES
1. Hoerr AL, Gao F, Hidalgo J, et al: Effects of pretransplantation treatment with rituximab on outcomes of autologous stem-cell transplantation for non-Hodgkin's lymphoma. J Clin Oncol 22:4561-4566, 2004 2. Guglielmi C, Gomez F, Philip T, et al: Time to relapse has prognostic value in patients with aggressive lymphoma enrolled onto the Parma trial. J Clin Oncol 16:3264-3269, 1998[Abstract]
3. Blay J, Gomez F, Sebban C, et al: The International Prognostic Index correlates to survival in patients with aggressive lymphoma in relapse: Analysis of the PARMA trial. Parma Group. Blood 92:3562-3568, 1998
4. Fisher RI, Gaynor ER, Dahlberg S, et al: Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med 328:1002-1006, 1993 5. Gutierrez-Delgado F, Maloney DG, Press OW, et al: Autologous stem cell transplantation for non-Hodgkin's lymphoma: Comparison of radiation-based and chemotherapy-only preparative regimens. Bone Marrow Transplant 28:455-561, 2001[CrossRef][Medline] Related Correspondence
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Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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