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Autografting

A phase II trial of rituximab as adjuvant to intensive sequential chemotherapy in patients under 60 years with untreated poor-prognosis diffuse large B-cell lymphoma

Abstract

The potential benefit of rituximab as adjuvant to high-dose therapy (HDT) has been investigated in patients under 60 years with poor-risk (age-adjusted international prognostic index at 2–3) CD20+ diffuse large B-cell lymphoma (DLBCL). The treatment consisted of four cycles of high-dose CEOP (cyclophosphamide, epirubicin, vincristine, prednisone), plus etoposide and cisplatin during the two last cycles. Peripheral blood stem cells were collected after cycle 1, and reinfused after cycles 3 and 4. Four weekly rituximab infusions were subsequently delivered. Among the 36 patients included, 30 could complete chemotherapy schedule, and 24/36 received rituximab. A complete response occured in 26/36 patients (72%). With a median follow-up of 30 months, the estimated 5-year overall survival (OS) and event-free survival (EFS) rates (mean±s.d.) were 65±16 and 63±15%, respectively. For the 24 patients who received both chemotherapy and rituximab, the estimated 5-year OS and EFS rates were 86±14 and 82±15%. These data suggest that rituximab after HDT is feasible. Both complete remission rate and survival curves compare favorably with the poor outcome usually observed in high-risk DLBCL patients managed with HDT without rituximab.

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References

  1. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J et al. The World Health Organization classification of neoplasms of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting – Airlie House, Virginia, November, 1997. Hematol J 2000; 1: 53–66.

    Article  CAS  PubMed  Google Scholar 

  2. The international non-Hodgkin's lymphoma prognostic factors project: a predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993; 329: 987–994.

  3. Haioun C, Lepage E, Gisselbrecht C, Bastion Y, Coiffier B, Brice P et al. Benefit of autologous bone marrow transplantation over sequential chemotherapy in poor-risk aggressive non Hodgkin's lymphoma: Updated results of the prospective study LNH87-2. J Clin Oncol 1997; 15: 1131–1137.

    Article  CAS  PubMed  Google Scholar 

  4. Santini G, Salvagno L, Leoni P, Chisesi T, De Souza C, Sertoli MR et al. VACOP-B versus VACOP-B plus autologous bone marrow transplantation for advanced diffuse non Hodgkin's lymphoma: Results of a prospective randomized trial by the non Hodgkin's lymphoma cooperative study group. J Clin Oncol 1998; 16: 2796–2802.

    Article  CAS  PubMed  Google Scholar 

  5. Haioun C, Lepage E, Gisselbrecht C, Thieblemont C, Simon D, Rose C et al. Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin's lymphoma: final analysis of the prospective LNH87-2 protocol – A Groupe d'Etude des Lymphomes de l'Adulte Study. J Clin Oncol 2000; 18: 3025–3030.

    Article  CAS  PubMed  Google Scholar 

  6. Milpied N, Deconinck E, Gaillard F, Delwail V, Foussard C, Berthou C et al. Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 2004; 350: 1287–1295.

    Article  CAS  PubMed  Google Scholar 

  7. Shipp MA, Neuberg D, Janicck M, Canellos GP, Shulman LN . High-dose CHOP as initial therapy for patients with poor-prognosis aggressive non Hodgkin's lymphoma. A dose-finding pilot study. J Clin Oncol 1995; 13: 2916–2923.

    Article  CAS  PubMed  Google Scholar 

  8. Gianni AM, Bregni M, Siena S, Brambilla C, Di Nicola M, Lombardi F et al. High-dose chemotherapy and autologous bone marrow transplantation compared with MACOP-B in aggressive B-cell lymphoma. N Engl J Med 1997; 336: 1290–1297.

    Article  CAS  PubMed  Google Scholar 

  9. Stoppa AM, Bouabdallah R, Chabannon C, Novakovitch G, Vey N, Camerlo J et al. Intensive sequential chemotherapy with repeated blood stem-cell support for untreated poor-prognosis non Hodgkin's lymphoma. J Clin Oncol 1997; 15: 1722–1729.

    Article  CAS  PubMed  Google Scholar 

  10. Bouabdallah R, Stoppa AM, Rossi JF, Lepeu G, Coso D, Xerri L et al. Intensive sequential chemotherapy (ISC 95) with growth factors and blood stem cell support in high-intermediate and highrisk (IPI 2 and IPI 3) aggressive non Hodgkin's lymphoma: an oligocentric report on 42 patients. Leukemia 1999; 13: 950–956.

    Article  CAS  PubMed  Google Scholar 

  11. Bouabdallah R, Stoppa AM, Coso D, Bardou VJ, Blaise D, Chabannon C et al. Clinical outcome after front-line intensive sequential chemotherapy (ISC) in patients with aggressive non-Hodgkin's lymphoma and high-risk international prognostic index (IPI 3): final analysis of survival in two consecutive ISC trials. Ann Oncol 2001; 12: 513–517.

    Article  CAS  PubMed  Google Scholar 

  12. Greb A, Schiefer DH, Bohlius J, Schwarzer G, Engert A . High-dose chemotherapy with autologous stem cell support is not superior to conventional-dose chemotherapy in the first-line treatment of aggressive non-Hodgkin's lymphoma – results of a comprehensive meta-analysis. Blood 2004; 104 (abstract # 920).

  13. Coiffier B, Haioun C, Ketterer N, Engert A, Tilly H, Ma D et al. Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing or refractory aggressive lymphoma: a multicenter phase II study. Blood 1998; 92: 1927–1932.

    CAS  PubMed  Google Scholar 

  14. Coiffier B, Lepage E, Brière J, Herbrecht R, Tilly H, Bouabdallah R et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B-cell lymphoma. N Engl J Med 2002; 346: 235–242.

    Article  CAS  PubMed  Google Scholar 

  15. Habermann TM, Weller E, Morrison VA, Cassileth PA, Cohn J, Dakhil S et al. Rituximab–CHOP versus CHOP with or without maintenance rituximab in patients 60 years of age or older with diffuse large B-cell lymphoma: an update. Blood 2004; 104 (abstract # 127).

  16. Pfreundschuh M, Truemper L, Gill D, Osterborg A, Pettengell R, Trneny M et al. First analysis of the completed Mabhtera International Trial (MinT) in young patients with low-risk diffuse large B-cell lymphoma (DLBCL): addition of rituximab to a CHOP-like regimen significantly improves outcome of all patients with the identification of a very favourable subgroup with IPI=0 and no bulky disease. Blood 2004; 104 (abstract # 157).

  17. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. J Clin Oncol 1999; 17: 1244–1253.

    Article  CAS  PubMed  Google Scholar 

  18. Horwitz SM, Negrin RS, Blume KG, Breslin S, Stuart MJ, Stockerl-Goldstein KE et al. Rituximab as adjuvant to high-dose therapy and autologous hematopoietic cell transplantation for aggressive non-Hodgkin lymphoma. Blood 2004; 103: 777–783.

    Article  CAS  PubMed  Google Scholar 

  19. Zanni M, Di Nicola M, Patti C, Castellino C, Pescarollo A, Zoli V et al. Rituximab-supplemented high-dose sequential (HDS) chemotherapy with autograft is highly effective in high-risk (aaIPI 2-3) diffuse large B-cell lymphoma: Results of a prospective multicenter study on 91 consecutive patients treated at diagnosis. Blood 2004; 104 (abstract # 891).

  20. Milpied NJ, Lamy T, Casassus P, Deconninck E, Gressin R, Maisonneuve H et al. Front-line high-dose chemotherapy (HDT) combined with rituximab for adults with aggressive large B-cell lymphoma (DLBCL): GOELAMS 074 trial. Blood 2004; 104 (abstract # 902).

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Correspondence to R Bouabdallah.

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Coso, D., Sebban, C., Boulat, O. et al. A phase II trial of rituximab as adjuvant to intensive sequential chemotherapy in patients under 60 years with untreated poor-prognosis diffuse large B-cell lymphoma. Bone Marrow Transplant 38, 217–222 (2006). https://doi.org/10.1038/sj.bmt.1705414

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