Limited‐stage diffuse large B‐cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy

Campbell, Belinda A.; Connors, Joseph M.; Gascoyne, Randy D.; Morris, William; Pickles, Tom; Sehn, Laurie H.

doi:10.1002/cncr.26687

Cited by 48 publications

(17 citation statements)

References 32 publications

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“…5,[24][25][26] Consolidation therapy with radiation has shown a benefit for R-CHOP-treated patients with limited stage disease. [27][28][29] However, less than 3% of patients in NHL13 received planned radiation therapy. This may be important for further studies in patients with bulky disease.…”

Section: P=0045; Data Not Shown)mentioning

confidence: 99%

Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial

et al. 2015

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We investigated rituximab maintenance therapy in patients with diffuse large B-cell lymphoma (n=662) or follicular lymphoma grade 3b (n=21) in first complete remission. Patients were randomized to rituximab maintenance (n=338) or observation (n=345). At a median follow-up of 45 months, the event-free survival rate (the primary endpoint) at 3 years was 80.1% for rituximab maintenance versus 76.5% for observation. This difference was not statistically significant for the intent-to-treat population (likelihood ratio P=0.0670). The hazard ratio by treatment arm was 0.79 (95% confidence interval 0.57-1.08; P=0.1433). The secondary endpoint, progression-free survival was also not met for the whole statistical model (likelihood ratio P=0.3646). Of note, rituximab maintenance was superior to observation when treatment arms only were compared (hazard ratio: 0.62; 95% confidence interval 0.43-0.90; P=0.0120). Overall survival remained unchanged (92.0 versus 90.3%). In subgroup analysis male patients benefited from rituximab maintenance with regards to both event-free survival (84.1% versus 74.4%) (hazard ratio: 0.58; 95% confidence interval 0.36-0.94; P=0.0267) and progression-free survival (89.0% versus 77.6%) (hazard ratio: 0.45; 95% confidence interval 0.25-0.79; P=0.0058). Women had more grade 3/4 adverse events (P=0.0297) and infections (P=0.0341). Men with a low International Prognostic Index treated with rituximab had the best outcome. In summary, rituximab maintenance in first remission after R-CHOP-like treatment did not prolong event-free, progression-free or overall survival of patients with aggressive B-non-Hodgkin lymphoma. The significantly better outcome of men warrants further studies prior to the routine use of rituximab maintenance in men with low International Prognostic Index. This trial is registered under EUDRACT #2005-005187-90 and www.clinicaltrials.gov as #NCT00400478.

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Section: P=0045; Data Not Shown)mentioning

confidence: 99%

Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial

et al. 2015

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“…104,105 In patients who do require radiation, a retrospective review suggests that the use of involved nodal radiation therapy appears equivalent to IFRT and may reduce the risk of long-term complications. 106 In the future, a personalized treatment approach that relies more on biological characteristics rather than stage of disease will likely be used.…”

mentioning

confidence: 99%

Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity

Sehn

Gascoyne

2015

Blood

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469

358

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Although the majority of patients with diffuse large B-cell lymphoma (DLBCL) can be cured with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), patients who fail R-CHOP have a dismal outcome. Thus, optimization of front-line therapy, as well as the development of more effective salvage strategies, remains an important objective. Advances in molecular genetics have vastly improved our understanding of the biological diversity of DLBCL and have led to the discovery of key oncogenic pathways. In addition to the major molecular designations of germinal center B-cell and activated B-cell subtypes, next-generation sequencing technologies have unveiled the remarkable complexity of DLBCL and identified unique molecular targets that may be differentially exploited for therapeutic benefit. These findings have translated into a growing list of promising novel agents. Moving forward, it is of paramount importance to recognize the heterogeneity of DLBCL and to investigate these targeted agents within patient populations who are most likely to benefit. It will be necessary to prioritize drugs that affect key driver pathways and to combine them rationally to optimize their benefit. Improved prognostication and the availability of predictive biomarkers will be crucial to allow for the possibility of individualized risk-adapted therapy.

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“…In patients who do require radiation, a retrospective review suggests that the use of involved nodal radiation therapy (INRT) appears equivalent to IFRT and may reduce the risk of long-term complications [65,66].…”

Section: Chemoterapy In Limited Stagementioning

confidence: 99%

The importance of radiotherapy on diffuse large B cell lymphoma treatment: a current review

Mendes

Domingues

Teixo

et al. 2015

Cancer Metastasis Rev

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Diffuse large B cell lymphoma is recognized as a heterogeneous group of hematological malignancies; two main subtypes germinal center B and activated B cells are well defined although 15% of patients remain with unclassifiable disease. R-CHOP treatment has proven to provide very effective results in limited or advanced stage of the disease. However, treatment solely involving R-CHOP submits the patient to possible chemotherapy-induced toxicities, which may be avoided with the use of radiotherapy. Patients with early stage localized disease or who are particularly unresponsive to chemotherapy may be more suitable for mixed modality treatment with R-CHOP and consolidative radiotherapy. Although radiotherapy is being slowly phased out by other treatment strategies including chemotherapy and therapeutic drugs, it is still a highly important method of treatment. The different forms of radiotherapy can be used alongside these "new-age" treatment strategies to further improve prognostic outcomes and overall survival rates. The establishment of radiotherapy as a treatment strategy provides a highly beneficial prognostic advantage in early stage, localized disease.

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Limited‐stage diffuse large B‐cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy

Cited by 48 publications

References 32 publications

Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial

Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial

Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity

The importance of radiotherapy on diffuse large B cell lymphoma treatment: a current review

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