Outcomes of rituximab‐BEAM versus BEAM conditioning regimen in patients with diffuse large B cell lymphoma undergoing autologous transplantation

Abstract

Background Although rituximab‐based high‐dose therapy is frequently used in diffuse large B cell lymphoma (DLBCL) patients undergoing autologous hematopoietic cell transplantation (auto‐HCT), data supporting the benefits are not available. Herein, we report the impact of rituximab‐based conditioning on auto‐HCT outcomes in patients who have DLBCL. Methods Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, 862 adult DLBCL patients undergoing auto‐HCT between 2003 and 2017 using BEAM (BCNU, etoposide, cytarabine, melphalan) conditioning regimen were included. All patients received frontline rituximab‐containing chemoimmunotherapy and had chemosensitive disease pre‐HCT. Early chemoimmunotherapy failure was defined as not achieving complete remission (CR) after frontline chemoimmunotherapy or relapse within 1 year of initial diagnosis. The primary outcome was overall survival (OS). Results The study cohort was divided into 2 groups: BEAM (n = 667) and R‐BEAM (n = 195). On multivariate analysis, no significant difference was seen in OS (P = .83) or progression‐free survival (PFS) (P = .61) across the 2 cohorts. No significant association between the use of rituximab and risk of relapse (P = .15) or nonrelapse mortality (P = .12) was observed. Variables independently associated with lower OS included older age at auto‐HCT (P < .001), absence of CR at auto‐HCT (P < .001) and early chemoimmunotherapy failure (P < .001). Older age (P < .0002) and non‐CR pre‐HCT (P < .0001) were also associated with inferior PFS. There was no significant difference in early infectious complications between the 2 cohorts. Conclusion In this large registry analysis of DLBCL patients undergoing auto‐HCT, the addition of rituximab to the BEAM conditioning regimen had no impact on transplantation outcomes. Older age, absence of CR pre auto‐HCT, and early chemoimmunotherapy failure were associated with inferior survival.

Worked to the bone: antibody-based conditioning as the future of transplant biology

“…In many studies comparing rituximab vs non-rituximab cohorts, the non-rituximab cohort has already received rituximab as therapy. Only 9% of adult allo-HCT patients in the CIBMTR registry received rituximab in their conditioning regimen, and in the trials investigating BEAM versus rituximab–BEAM conditioning, 76% of the non-rituximab group had rituximab exposure immediately before HCT [ 32 , 33 ]. No difference was seen in survival or relapse outcomes [ 32 , 33 ].…”

Immunotherapy for Diffuse Large B-Cell Lymphoma: Current Landscape and Future Directions

“…The BMT CTN 0401 study substituted rituximab with radioimmunotherapy, as a part of the BEAM conditioning regimen, and did not observe an improvement in outcomes [ 32 ]. The Center for International Blood and Marrow Transplant Research (CIBMTR) registry study did not observe any difference in OS, PFS, relapse, or non-relapse mortality (NRM) with the addition of rituximab to the BEAM conditioning regimen in 862 relapsed chemo-sensitive DLBCL patients undergoing autoSCT [ 33 ].…”

Modified conditioning regimen with chidamide and high‐dose rituximab for triple‐hit lymphoma

“…However, whether B‐NHL patients could benefit from rituximab‐based conditioning regimen are still unknown. Jagadeesh et al reported that the addition of high‐dose rituximab (>375 mg/m 2 ) to the BEAM conditioning regimen had no impact on transplantation outcomes 10 . However, Shi et al demonstrated that high‐dose rituximab followed with auto‐HSCT is a feasible and promising treatment for relapsed or refractory DLBCL 11 .…”

“…Jagadeesh et al reported that the addition of high‐dose rituximab (>375 mg/m 2 ) to the BEAM conditioning regimen had no impact on transplantation outcomes. 10 However, Shi et al demonstrated that high‐dose rituximab followed with auto‐HSCT is a feasible and promising treatment for relapsed or refractory DLBCL. 11 Chen et al reported that primary central nervous system (CNS) DLBCL patients gained perfect efficacy receiving high‐dose rituximab (1000 mg/m 2 ) followed with auto‐HSCT.…”