Conventional chemotherapy (CHOEP-14) with rituximab or high-dose chemotherapy (MegaCHOEP) with rituximab for young, high-risk patients with aggressive B-cell lymphoma: an open-label, randomised, phase 3 trial (DSHNHL 2002-1)

Schmitz, Norbert; Nickelsen, Maike; Ziepert, Marita; Haenel, Mathias; Borchmann, Peter; Schmidt, Christian; Viardot, Andreas; Bentz, Martin; Peter, Norma; Ehninger, Gerhard; Doelken, Gottfried; Ruebe, Christian; Truemper, Lorenz; Rosenwald, Andreas; Pfreundschuh, Michael; Loeffler, Markus; Glaß, Bertram

doi:10.1016/s1470-2045(12)70481-3

Cited by 223 publications

(175 citation statements)

References 30 publications

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“…5,6 One of the largest randomized trials incorporating ASCT conducted without positron emission tomography (PET) scans failed to show an obvious benefit of early dose-escalated sequential HDT. 7 Similar trials used a variety of study designs, and the value of treatment intensification remains unresolved; suffice to say that such treatment is feasible, but at the price of greater toxicity than that associated with the current standard treatment. A more individualized approach, such as interim PET-based risk stratification, would allow the selection of high-risk patients for treatment intensification, while at the same time avoiding unnecessary toxicity in patients destined to do well with R-CHOP alone.…”

Section: Introductionmentioning

confidence: 99%

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

et al. 2016

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I n the treatment of diffuse large B-cell lymphoma, a persistently positive [ 18 F]fluorodeoxyglucose positron emission tomography (PET) scan typically carries a poor prognosis. In this prospective multi-center phase II study, we sought to establish whether treatment intensification with R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) chemotherapy followed by 90Y-ibritumomab tiuxetan-BEAM (BCNU, etoposide, cytarabine, and melphalan) for high-risk diffuse large B-cell lymphoma patients who are positive on interim PET scan after 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, and prednisone) can improve 2-year progression-free survival from a historically unfavorable rate of 40% to a rate of 65%. Patients received 4 cycles of R-CHOP-14, followed by a centrally-reviewed PET performed at day 17-20 of cycle 4 and assessed according to International Harmonisation Project criteria. Median age of the 151 evaluable patients was 57 years, with 79% stages 3-4, 54% bulk, and 54% International Prognostic Index 3-5. Among the 143 patients undergoing interim PET, 101 (71%) were PET-negative (96 of whom completed R-CHOP), 42 (29%) were PETpositive (32 of whom completed R-ICE and 90Y-ibritumomab tiuxetan-BEAM). At a median follow up of 35 months, the 2-year progressionfree survival for PET-positive patients was 67%, a rate similar to that for

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Section: Introductionmentioning

confidence: 99%

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

et al. 2016

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“…15 The anti-CD20 monoclonal antibody rituximab used in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy is standard treatment for DLBCL. [16][17][18][19][20][21][22] However, there is a need to further improve treatment outcomes, as the 2-year PFS rate of a large populationbased analysis of R-CHOP was only 69%. 23 In a second SWOG study, the feasibility and safety of adding bevacizumab to R-CHOP (RA-CHOP) was explored in 13 patients with newly diagnosed DLBCL.…”

Section: Introductionmentioning

confidence: 99%

R-CHOP with or without bevacizumab in patients with previously untreated diffuse large B-cell lymphoma: final MAIN study outcomes

et al. 2014

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“…In aaIPI = 1, better survival has been demonstrated with the more intensive regimen rituximab-doxorubicin-cyclophosphamidevindesine-bleomycin-prednisone (R-ACVBP) than R-CHOP-without-irradiation (Recher et al, 2011). In aaIPI ≥ 2, rituximab was combined with CHOP-etoposide (R-CHOEP), which is now common in Europe, but not in North America, where R-CHOP is given to most patients (Armitage, 2012;Schmitz et al, 2012). Recent Scandinavian registry studies suggest that R-CHOEP is preferable to R-CHOP in younger high-risk patients (Gang et al, 2012;Wasterlid et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Chemotherapeutic intensity and survival differences in young patients with diffuse large B‐cell lymphoma: a Swedish Lymphoma Registry study

et al. 2016

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Summary Young patients with diffuse large B‐cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide‐doxorubicin‐vincristine‐prednisone (R‐CHOP), CHOP‐etoposide (R‐CHOEP), and anthracycline‐based regimens with the addition of high‐dose cytarabine/methotrexate (R‐HDA/M). Using the nationwide, population‐based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age‐adjusted international prognostic index (aaIPI) ≥ 2, the 5‐year overall survival (OS) was 70%, 76% and 85% after R‐CHOP, R‐CHOEP and R‐HDA/M, respectively (P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aaIPI = 3 (P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI ≥ 2: three were “Moderate” (more R‐CHOP) and three “Intensive” (more R‐CHOEP and R‐HDA/M). Patients with aaIPI ≥ 2 who were treated in the Intensive Regions, showed better OS (P < 0·00005), particularly those with aaIPI = 3 (5‐year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aaIPI < 2. We conclude that in younger high‐risk patients, survival appears superior after more intensive therapy than R‐CHOP.

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Conventional chemotherapy (CHOEP-14) with rituximab or high-dose chemotherapy (MegaCHOEP) with rituximab for young, high-risk patients with aggressive B-cell lymphoma: an open-label, randomised, phase 3 trial (DSHNHL 2002-1)

Cited by 223 publications

References 30 publications

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

R-CHOP with or without bevacizumab in patients with previously untreated diffuse large B-cell lymphoma: final MAIN study outcomes

Chemotherapeutic intensity and survival differences in young patients with diffuse large B‐cell lymphoma: a Swedish Lymphoma Registry study

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