Survival impact of rituximab combined with ACVBP and upfront consolidation autotransplantation in high-risk diffuse large B-cell lymphoma for GELA

Abstract

BackgroundAs rituximab combined with CHOP improves complete remission and overall survival in diffuse large B-cell lymphoma, intensified chemotherapy followed by autologous stem-cell transplantation has also been advocated for high-risk patients. The aim of this study was to establish whether or not combining rituximab with high-dose chemotherapy and auto-transplantation also benefits patient survival. Design and MethodsThe LNH2003-3 study was a phase II trial including diffuse large B-cell lymphoma patients with 2 or 3 International Prognostic Index factors. They received four cycles of intensive biweekly chemotherapy with rituximab, doxorubicine, cyclophosphamide, vindesine, bleomycine, prednisolone (R-ACVBP) followed by auto-transplantation in responding patients. Two hundred and nine patients under 60 years of age were included in the study and 155 responding patients underwent auto-transplantation. In addition, a case-control study was performed by matching (1:1) 181 patients treated with R-ACVBP with ACVBP patients not given rituximab but submitted to auto-transplantation from the previous LNH1998-3 trial. ResultsWith a median follow up of 45 months, 4-year progression-free survival and overall survival were estimated at 76% (CI: 69-81) and 78% (CI: 72-83), respectively. There was no difference between patients with 2 or 3 International Prognostic Index factors. Four year progression-free survival was significantly higher in R-ACVBP than ACVBP patients (74% vs. 58%; P=0.0005). There was also a significant increase in 4-year overall survival (76% vs. 68%; P=0.0494). ConclusionsIn high-risk diffuse large B-cell lymphoma patients, treatment with R-ACVBP followed by auto-transplantation results in a 78% 4-year overall survival which should be compared to other approaches. (ClinicalTrials.gov identifier: NCT00144807) Key words: follicular lymphoma, autologous stem cell transplantation, rituximab.Citation: Fitoussi O, Belhadj K, Mounier N, Parrens M, Tilly H, Salles G, Feugier P, Ferme C, Ysebaert L, Gabarre J, Herbrecht R, Janvier M, Van Den Neste E, Morschhauser F, Casasnovas O, Ghesquieres H, Anglaret B, Brechignac S, Haioun C, and Gisselbrecht C. Survival Survival impact of rituximab combined with ACVBP and upfront consolidation autotransplantation in high-risk diffuse large B-cell lymphoma for GELA

MYC-IG rearrangements are negative predictors of survival in DLBCL patients treated with immunochemotherapy: a GELA/LYSA study

“…Details regarding the design and data management of the LNH03-2B, 03-3B, and 03-7B trials have been published. [29][30][31][32] Treatments included R-CHOP21/14 (03-6B, 03-2B, 01-5B), R-mini-CHOP21 (03-7B), and R-ACVBP or ACVBP (03-1B and 03-3B, 03-39B) regimens. The trials are individually registered at clinicaltrials.gov as noted previously.…”

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“…Symptoms range from mild upper respiratory tract infection to severe pneumonia requiring mechanical ventilation. Patients with hematologic diseases, especially hematopoietic stem cell transplantation (HSCT) recipients are likely to be at increased risk of infection with a prolonged clinical course (4). Materials (or patients) and methods: We describe our experience with three HSCT patients diagnosed with hMPV infection.…”

“…Control population is represented by a cohort of pts with the same clinical characteristics, treated in the same years, with the same conditioning regimen, graft, aGVHD prophylaxis and that ar in CR at 100 days after HSCT. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] procedures was performed, without any complication due to ECP. In ECP group we observed cGVHD in 9715 pts (60%), after a median time of 11 (7-21) months from HSCT, with a grading of severe in 1 (6%), moderate in 6 (40%) and mild in 2 (13%).…”

“…While Harper et al 1996 could prove better initial transplant function and decreased rejection in renal transplantation the in HSCT were inconclusive. In humans, a oral dose of 10 mg induces a decrease in blastogenesis and IL-2 production [3,4]. The effect is prolonged in NK-cells, whose cytotoxic process are susceptible to nifedipine [4,5].…”

“…In humans, a oral dose of 10 mg induces a decrease in blastogenesis and IL-2 production [3,4]. The effect is prolonged in NK-cells, whose cytotoxic process are susceptible to nifedipine [4,5]. Materials (or patients) and methods: After HSCT and during prophylaxis to control graft-versus-host disease (aGVHD), 108 consecutive recipients were retrospectively investigated for concomitant nifedipine and ketokonazole (NA) treatment.…”