Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era.

Détails

ID Serval
serval:BIB_7639F25E40FA
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era.
Périodique
Journal of Clinical Oncology
Auteur(s)
Gisselbrecht C., Glass B., Mounier N., Singh Gill D., Linch D.C., Trneny M., Bosly A., Ketterer N., Shpilberg O., Hagberg H., Ma D., Brière J., Moskowitz C.H., Schmitz N.
ISSN
1527-7755[electronic], 0732-183X[linking]
Statut éditorial
Publié
Date de publication
2010
Volume
28
Numéro
27
Pages
4184-4190
Langue
anglais
Résumé
PURPOSE: Salvage chemotherapy followed by high-dose therapy and autologous stem-cell transplantation (ASCT) is the standard treatment for relapsed diffuse large B-cell lymphoma (DLBCL). Salvage regimens have never been compared; their efficacy in the rituximab era is unknown.
PATIENTS AND METHODS: Patients with CD20(+) DLBCL in first relapse or who were refractory after first-line therapy were randomly assigned to either rituximab, ifosfamide, etoposide, and carboplatin (R-ICE) or rituximab, dexamethasone, high-dose cytarabine, and cisplatin (R-DHAP). Responding patients received high-dose chemotherapy and ASCT. RESULTS: The median age of the 396 patients enrolled (R-ICE, n = 202; R-DHAP, n = 194) was 55 years. Similar response rates were observed after three cycles of R-ICE (63.5%; 95% CI, 56% to 70%) and R-DHAP (62.8%; 95 CI, 55% to 69%). Factors affecting response rates (P < .001) were refractory disease/relapse less than versus more than 12 months after diagnosis (46% v 88%, respectively), International Prognostic Index (IPI) of more than 1 versus 0 to 1 (52% v 71%, respectively), and prior rituximab treatment versus no prior rituximab (51% v 83%, respectively). There was no significant difference between R-ICE and R-DHAP for 3-year event-free survival (EFS) or overall survival. Three-year EFS was affected by prior rituximab treatment versus no rituximab (21% v 47%, respectively), relapse less than versus more than 12 months after diagnosis (20% v 45%, respectively), and IPI of 2 to 3 versus 0 to 1 (18% v 40%, respectively). In the Cox model, these parameters were significant (P < .001). CONCLUSION: In patients who experience relapse more than 12 months after diagnosis, prior rituximab treatment does not affect EFS. Patients with early relapses after rituximab-containing first-line therapy have a poor prognosis, with no difference between the effects of R-ICE and R-DHAP.
Pubmed
Web of science
Création de la notice
25/08/2010 13:46
Dernière modification de la notice
03/03/2018 18:25
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