Dose dense (CEOP-14) vs dose dense and rituximab (CEOP-14+R) in high-risk diffuse large cell lymphoma

Avilés, Agustín; Nambo, M. Jesús; Neri, Natividad; Cleto, Sérgio; Castañeda, Claudia; Huerta‐Guzmán, Judith; Murillo, Edgar; Contreras, Margarita L.; Talavera, Alejandra; González, Martha

doi:10.1007/bf02685907

Cited by 15 publications

(9 citation statements)

References 21 publications

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“…Many reactions developed within 24 hours of the first infusion, were dose-dependent, and were often more common in those who received rituximab versus those receiving the conventional chemotherapy regimen [4,14,37-39]. The frequency of the reactions decreased with subsequent cycles, and life-threatening anaphylaxis was rare [14,36,40].…”

Section: Resultsmentioning

confidence: 99%

“…However, cytopenia was more common in chemotherapy trials of regimens in which rituximab was combined with agents more frequently associated with myelosuppression [39,45,46]. For example, granulocytopenia (grades 3 and 4) occurred in 72% of R-CHOP-treated patients compared with 57% of CHOP-treated patients in 64 patients with lymphoplasmacytic lymphoma/Waldenström macro-globulinemia [45].…”

Section: Resultsmentioning

confidence: 99%

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Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective

et al. 2012

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The advent of biologic agents has provided a more specific and targeted approach to the treatment of various hematological malignancies and other autoimmune disorders. Such biologic agents have been relatively well tolerated with fewer adverse events reported as compared with many other chemotherapeutic agents. Rituximab is a monoclonal antibody to the B-cell marker CD20 and is a common biologic agent widely used for the treatment of B-cell lymphoma, lymphoproliferative disorders, and inflammatory conditions that are refractory to conventional treatment, including rheumatoid arthritis and some vasculitides. However, through randomized controlled trials and post-marketing surveillance, an increasing number of serious adverse events are being associated with the use of rituximab, often leading to or complicating an intensive care unit admission. The purpose of this review is to focus on the severe complications that are associated with the use of rituximab and that require critical care. Management and prevention strategies for the most common complications along with some examples of its uses within the critical care setting are also discussed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective

et al. 2012

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“…Rituximab is a monoclonal antibody against the B-cell marker CD20 and is used in a variety of conditions including lymphoproliferative disorders and autoimmune diseases [1, 2, 3]. Rituximab is usually well tolerated.…”

Section: Discussionmentioning

confidence: 99%

Rituximab and Cytokine Release Syndrome

Kulkarni¹,

Kasi

2012

Case Rep Oncol

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Rituximab is a biologic agent that is usually well tolerated. With its increasing use for a myriad of rheumatologic and immunologic conditions, post-marketing surveillance has revealed more side effects. Systemic inflammatory response syndrome associated with cytokine release syndrome (CRS) is a very rare entity associated with the use of rituximab and carries a very high morbidity and case fatality rate. Cases of CRS reported within the literature are of patients with a very high tumor burden leading to a catastrophic cascade of events. We report the case of a patient having post-transplant lymphoproliferative disorder who died of fatal lactic acidosis and CRS within 24 h of receiving rituximab. Understanding the pathophysiology of such cases and identifying patients at risk may help to possibly avert this life-threatening complication.

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“…Thus, they suggested that R cannot be employed in this clinical situation. 13,14 Maintenance therapy has been employed after induction regimens in DLBCL and has used low doses of cytotoxic drugs, 15 interferon after standard CHOP, 16 and with the use of intensive or dose-dense regimens, [17][18][19] induction of graftversus-host disease, 20 SCT after CHOP or R-CHOP 21 ; however, no clear benefit has observed. On the other hand, late toxicities continue to be a problem that can be intensified with the use of maintenance therapy.…”

Section: Discussionmentioning

confidence: 99%

Rituximab as Consolidation Therapy Did Not Improve Outcome in Patients with Diffuse Large B-Cell Lymphoma at Complete Response After Dose-Dense Chemotherapy (CHOP-14)

AvilèsAgustin

NamboMaria-Jesùs

Huerta-GuzmànJudith

et al. 2015

Cancer Biotherapy and Radiopharmaceuticals

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The authors started a clinical trial to assess the efficacy and toxicity of rituximab (R) as consolidation in patients with diffuse large B-cell lymphoma, with poor prognostic factors, who were in complete response (CR) after dose-dense chemotherapy (CHOP-14). Four hundred sixty-five untreated patients, with advanced stages (III and IV), older (median age >60 years old), and high clinical risk, were treated with dose-dense CHOP-14 (cyclophosphamide 1500 mg/m(2), i.v., day 1; vincristine 2 mg, i.v., standard dose, day 1; epirubicin 120 mg/m(2), i.v., day 1; and prednisone 60 mg/m(2), p.o., days 1-5) every 14 days for six cycles. If CR was achieved, the patients were allocated to receive R (375 mg/m(2), days 1, 8, 15, and 22) at 3 and 9 months after chemotherapy. Three hundred twenty-five patients achieved CR (70%) and were allocated to receive R (151 patients) or not (174 patients). Actuarial curves at 5 years showed that progression-free survival (PFS) was 51% (95% confidence interval [CI]: 44%-58%) in the R group and 53% (95% CI: 47%-59%) in the observation group (p=0.8). Overall survival (OS) was 65% (95% CI: 58%-71%) and 66% (95% CI: 59%-72%), respectively (p=0.78). Late toxicities were more frequent in the R group. The authors showed that the use of R as a consolidation treatment was not useful to improve PFS and OS and toxicity secondary to R was frequent. They did not recommend the use of R as consolidation in this patient setting.

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Dose dense (CEOP-14) vs dose dense and rituximab (CEOP-14+R) in high-risk diffuse large cell lymphoma

Cited by 15 publications

References 21 publications

Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective

Clinical review: Serious adverse events associated with the use of rituximab - a critical care perspective

Rituximab and Cytokine Release Syndrome

Rituximab as Consolidation Therapy Did Not Improve Outcome in Patients with Diffuse Large B-Cell Lymphoma at Complete Response After Dose-Dense Chemotherapy (CHOP-14)

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