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)

Abstract

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.

Gemcitabine Rituximab Dexamethasone and Thalidomide as Maintenance in the Treatment of Relapse/Refractory Diffuse Large B-cell Lymphoma

“…Actually, Stem Cell Therapy (SCT) is acceptable in those the best treatment but most patients are no candidates, for poor performance status, severe comorbidities, age (>70 years), and the refusal of the patient that has been limited the use of these treatment. Most of the treatments of R/R lymphomas, including anthracyclines, steroids and rituximab, recently new drugs as ibrutinib, lenalidomide and bortezomib has been adding, but, no clear improved in outcome has been observed [6,7] Gemcitabine is a agent that has been developed in the treatment of solid tumors [8,9] and has been demonstrated clinical activity against non-Hodgkin lymphoma; generally combined with cisplatin and dexamethasone [10,11]. Rituximab is a monoclonal antibody anti CD-20, that associated to anthracyclines-based chemotherapy remain to be the most effectively agent in patients with DLBCL.…”

Early Primary Gastric Lymphoma with Adverse Prognosis Factors. Is it Benefit Adding Rituximab to CHOP-14?

“…Thus, we developed an intensive regimen, that increase doses of cyclophosphamide, and doxorubicin, diminished the interval between cycles of 14 instead of 21 days, that achieve good response rate and outcome [6]. Rituximab has been considered as a golden drug in the treatment of DLBCL, but, in PGL, the results were conflictive thus we performed an open label clinical to assess the efficacy and toxicities of a dose dense with and without rituximab [7][8][9][10].…”