Maintenance rituximab versus observation after R-CHOP or R-EPOCH in patients with untreated poor-prognosis diffuse large B-cell lymphoma and grade III follicular lymphoma.

Li, Y. J.; Xia, Zhong Jun; Li, S.; Chen, X. Q.; Xia, Yuwei; Xu, Fan; Wang, Z. H.

doi:10.1200/jco.2010.28.15_suppl.8084

Cited by 2 publications

(19 citation statements)

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“…Maintenance therapy improved disease control compared to placebo with OR 0.74 (95% CI 0.65‐0.84, I 2 = 46%, 8 trials). Disease control was statistically significantly improved also in the subgroup of trials evaluating rituximab as maintenance, OR 0.61 (95% CI 0.47‐0.79, I 2 = 0%) (Figure ), and in the subgroup including R‐CHOP as the induction therapy with 7 trials demonstrating OR 0.77 (95% CI 0.67‐0.88, I 2 = 41%) (Figure ).…”

Section: Resultsmentioning

confidence: 97%

“…Median age of patients ranged between 49 and 70 years old. In 6 trials, only patients with intermediate‐high and high‐risk international prognostic index (IPI) or age‐adjusted IPI were included . In 4 trials, patients with any IPI were included .…”

Section: Resultsmentioning

confidence: 99%

“…In 7 trials, rituximab was given to all patients, and in 1 trial, rituximab was added to induction in 50% of patients by randomization . Nine trials included either different induction therapy regimens or were randomized with CHOP . All those regimens are described in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Any type of maintenance treatment did not statistically significantly affect OS compared to observation or placebo, OR 0.91 (95% CI 0.78‐1.07, I 2 = 0, 3957 patients). The effect of rituximab maintenance was evaluated in four of those trials . Results were not changed in a subgroup analysis of trials evaluating rituximab as a maintenance therapy (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…Regarding induction therapy, 10 trials included either R-CHOP or CHOP alone. 2,10,11,[13][14][15][16][17][18][19] In 7 trials, rituximab was given to all patients, [10][11][12][13][14][15]17 and in 1 trial, rituximab was added to induction in 50% of patients by randomization. 2 Nine trials included either different induction therapy regimens or were randomized with CHOP.…”

Section: Induction Therapymentioning

confidence: 99%

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The role of maintenance therapy in patients with diffuse large B cell lymphoma: A systematic review and meta‐analysis

Rozental

Gafter‐Gvili

Vidal

et al. 2018

Hematological Oncology

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Randomized trials of maintenance therapy (MT) in diffuse large B cell lymphoma (DLBCL) are inconclusive regarding its effect on overall survival (OS) and disease control. We aimed to examine the efficacy and safety of MT in this meta-analysis. Systematic review and meta-analysis of randomized controlled trials comparing MT with observation or placebo, in patients with DLBCL, who achieved complete response (CR) or partial response (PR) after first-line chemotherapy with or without rituximab. Primary outcome was OS. Secondary outcomes included relapse rate, disease control (defined as progression-free survival, event-free survival, or disease-free survival, as reported in the original trials), and safety. Our search yielded 14 trials including 5122 patients. Median age of patients was 49 to 70 years. Six trials included rituximab as the MT; three included Interferon alfa; other trials include thalidomide, lenalidomide, cyclophosphamide and prednisone, serine threonine kinase inhibitor enzastaurin, and mTOR inhibitor everolimus. MT did not improve OS compared to observation, OR 0.91, (95% CI 0.78-1.07). Results were the same in a subgroup analysis by the type of maintenance (rituximab vs other). MT did decreased relapse rate, RR 0.76 (95% CI 0.65-0.89) and improved disease control, OR 0.74 (95% CI 0.65-0.84). Disease control was significantly improved in the subgroup of studies evaluating rituximab as maintenance OR 0.61 (95% CI 0.47-0.79) and in the subgroup of R-CHOP induction studies OR 0.77 (95% CI 0.67-0.88). Serious or grade III/IV adverse events including neutropenia and infections were significantly more common in the maintenance arm, RR = 1.69 (95% CI 1.29-2.22). MT in patients with DLBCL achieving CR or PR after induction therapy did not affect OS, yet it decreased relapse rate and improved disease control at the cost of higher infection rate. Our data do not support routine administration of MT in patients with DLBCL.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Induction Therapymentioning

confidence: 99%

See 3 more Smart Citations

The role of maintenance therapy in patients with diffuse large B cell lymphoma: A systematic review and meta‐analysis

Rozental

Gafter‐Gvili

Vidal

et al. 2018

Hematological Oncology

View full text Add to dashboard Cite

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Oral lenalidomide with rituximab in relapsed or refractory diffuse large cell, follicular and transformed lymphoma: a phase II clinical trial

et al. 2013

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Lenalidomide-rituximab therapy is effective in grade 1-2 follicular and mantle cell lymphoma, but its efficacy in diffuse large B-cell lymphoma (DLBCL), transformed large cell lymphoma (TL) and grade 3 follicular lymphoma (FLG3) is unknown. In this phase II trial, 45 patients with relapsed or refractory DLBCL (n=32), TL (n=9) or FLG3 (n=4) who had received 1-4 prior lines of treatment were given 20 mg oral lenalidomide on days 1-21 of each 28-day cycle, and intravenous rituximab (375 mg/m(2)) weekly during cycle 1. Grade 3/4 hematological toxicities included neutropenia (53%), lymphopenia (40%), thrombocytopenia (33%), leukopenia (27%) and anemia (18%), with a median follow-up time of 29.1 months (range 14.7-52.0 months). Overall response (OR) rate was 33%; median response duration was 10.2 months. Median progression-free survival (PFS) and overall survival (OS) were 3.7 and 10.7 months, respectively. Nine of the 15 responding patients (three partial response (PR), six complete response (CR)) proceeded with stem cell transplantation (SCT) and were censored at the time of transplantation. When data were analyzed without censoring, median PFS remained 3.7 months and response duration increased to 30.9 months. Rituximab plus oral lenalidomide is well tolerated and effective for patients with relapsed/refractory DLBCL and TL. SCT after lenalidomide-rituximab is associated with prolonged response duration.

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Maintenance rituximab versus observation after R-CHOP or R-EPOCH in patients with untreated poor-prognosis diffuse large B-cell lymphoma and grade III follicular lymphoma.

Cited by 2 publications

References 0 publications

The role of maintenance therapy in patients with diffuse large B cell lymphoma: A systematic review and meta‐analysis

The role of maintenance therapy in patients with diffuse large B cell lymphoma: A systematic review and meta‐analysis

Oral lenalidomide with rituximab in relapsed or refractory diffuse large cell, follicular and transformed lymphoma: a phase II clinical trial

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