Rituximab purging and maintenance therapy combined with autologous stem cell transplantation in patients with diffuse large B-cell lymphoma

Abstract

Abstract. The aim of this prospective, single-arm study was to test the efficacy and tolerability of autologous stem cell transplantation (auto-SCT) combined with in vivo rituximab purging and post-transplant rituximab maintenance therapy in patients with diffuse large B-cell lymphoma (DLBCL). This study included 12 DLBCL patients aged 18-65 years with an International Prognostic Index ≥2. The patients received 4-6 cycles of induction therapy consisting of rituximab plus cyclophosphamide, adriamycin, vincristine and prednisone followed by salvage therapy prior to stem cell mobilization. This regimen was followed by rituximab maintenance therapy (375 mg/m 2 every three months for two years). Prior to auto-SCT, six patients (50%) achieved complete remission (CR) and six (50%) achieved unconfirmed complete remission (CRu). Three months after transplantation, 11 patients (91.7%) achieved CR and one achieved CRu. After two cycles of rituximab maintenance therapy, all 12 patients achieved CR. Long-term CR was achieved by 10 patients, while two experienced relapse at 14 and 20 months after the end of rituximab maintenance therapy. The median follow-up period was 44 months (range 35-61). Disease-free survival was noted in 10 patients, while two experienced relapse. The three-year overall survival (OS) and progression-free survival (PFS) were 100 and 83%, respectively. Prolonged hypogammaglobulinemia occurred in two patients, although no increase in major infections was observed. Hepatitis B surface antigen was continuously negative in all 12 patients. Our results demonstrated that auto-SCT combined with in vivo rituximab purging and post-transplant rituximab maintenance is safe and effective, and may extend OS and PFS in younger high-risk DLBCL patients.

Autologous Stem Cell Transplantation for Transformed Lymphoma: Single-Center Experience

“…Novel agents currently investigated in maintenance therapy post-ASCT with immune mobdulators (lenalindomide), PD-1 inhibitors, Bruton tyrosine kinase inhibitors, Aurora A kinase inhibitors, and mTOR/PI3K inhibitors for DLBCL and indolent NHL are potential treatment options, which could alter the role of ASCT. [16][17][18][19] The need for prospective randomized controlled trials on TL is apparent.…”

Post-autologous transplant maintenance therapies in lymphoma: current state and future directions

“…One of the first single-arm studies to evaluate post-ASCT maintenance therapy in high-risk DLBCL by Zhang et al 10 utilized in vivo rituximab purging followed by maintenance rituximab (MR) given every 3 months for a total of two years post ASCT. At a median follow-up of 44 months, this approach demonstrated an 83% PFS and 100% overall survival (OS).…”

Role of Maintenance Therapy after High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation in Aggressive Lymphomas: A Systematic Review

“…Zhang et al [17] reported 3-year PFS of 83% and 3-year OS of 100% in 12 advanced-stage DLBCL patients who were treated with BEAM conditioning (carmustine, etoposide, cytarabine, and melphalan) followed by ASCT. In this study, patients received in vivo purging and MR was started on day þ100 after ASCT.…”