Inproceedings: An article in a conference proceedings.
Abstract (Abstract): shot summary in a article that contain essentials elements presented during a scientific conference, lecture or from a poster.
Early relapses and failure to achieve complete remission are the main prognostic factors in CD20 diffuse large B-cell lymphoma (DLBCL) treated with R-ICE or R-DHAP followed by stem cell transplantation in the CORAL study : 218
Title of the conference
10th International Conference on Malignant Lymphoma
4-7 June 2008, Lugano, Switzerland
Annals of Oncology
In relapsing pts with DLBCL, improvement in response rate of salvage chemotherapy with rituximab may improve the treatment with autologous stem cell transplantation (ASCT). In the CORAL trial, DLBCL CD 20+ in first relapse or pts refractory after first line therapy were randomized between rituximab plus DHAP and R-ICE. Responding pts received (BEAM) and ASCT were randomized between observation and maintenance with rituximab every 2 m. for 1 year. The interim analysis was performed on 194 pts (100 R ICE arm, 94 R DHAP arm): median age 55 yrs; 86 relapses >12months, 108 refractory/early relapses; 97 pts with prior exposure to rituximab; Stage 3-4 107 pts; elevated LDH 88 pts; secondary IPI 0-1, 112 pts, sIPI 2-3, 63pts. The ORR was 68%, with 41% CR. Factors affecting significantly (p<.0001) response rate were: refractory/relapse < 12 months 52% vs 88 %, secondary IPI >1 54% vs 77%, prior exposure to rituximab 54% vs 82%. Pts with prior rituximab exposure had significantly more refractory disease with more adverse prognostic factors. In a logistic regression model only refractory/early relapse and secondary IPI remain significant for response rate. Only 107 pts received, per protocol ASCT. For pts transplanted, 2 years EFS was 75% (CI 63-84%) with OS 89%. Two years EFS was affected by: prior treatment with rituximab, 34% vs 66% (p=.0001); refractory/early relapse 36% vs 68% (p <.0001); secondary IPI 2-3:39% vs 0-1: 56% (p=.03). Conclusion: Salvage chemotherapy incorporating rituximab provide a high 82% response rate in pts not previously treated with rituximab. Pts with early relapses or refractory after treatment including rituximab have a poor response rate and prognosis.
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