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Title: Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14
Authors: Hertzberg, Mark;Gandhi, Maher K;Trotman, Judith;Butcher, Belinda;Taper, John;Johnston, Amanda;Gill, Devinder;Ho, Shir-Jing;Cull, Gavin;Fay, Keith;Chong, Geoffrey;Grigg, Andrew P;Lewis, Ian D.;Milliken, Sam;Renwick, William;Hahn, Uwe;Filshie, Robin;Kannourakis, George;Watson, Anne-Marie;Warburton, Pauline;Wirth, Andrew;Seymour, John F;Hofman, Michael S;Hicks, Rodney J;Australasian Leukaemia and Lymphoma Group (ALLG)
Issue Date: Feb-2017
EDate: 2016-11-10
Citation: Haematologica 2017; 102(2): 356-363
Abstract: In the treatment of diffuse large B-cell lymphoma, a persistently positive [18F]fluorodeoxyglucose positron emission tomography (PET) scan typically carries a poor prognosis. In this prospective multi-center phase II study, we sought to establish whether treatment intensification with R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) chemotherapy followed by 90Y-ibritumomab tiuxetan-BEAM (BCNU, etoposide, cytarabine, and melphalan) for high-risk diffuse large B-cell lymphoma patients who are positive on interim PET scan after 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, and prednisone) can improve 2-year progression-free survival from a historically unfavorable rate of 40% to a rate of 65%. Patients received 4 cycles of R-CHOP-14, followed by a centrally-reviewed PET performed at day 17-20 of cycle 4 and assessed according to International Harmonisation Project criteria. Median age of the 151 evaluable patients was 57 years, with 79% stages 3-4, 54% bulk, and 54% International Prognostic Index 3-5. Among the 143 patients undergoing interim PET, 101 (71%) were PET-negative (96 of whom completed R-CHOP), 42 (29%) were PET-positive (32 of whom completed R-ICE and 90Y-ibritumomab tiuxetan-BEAM). At a median follow up of 35 months, the 2-year progression-free survival for PET-positive patients was 67%, a rate similar to that for PET-negative patients treated with R-CHOP-14 (74%, P=0.11); overall survival was 78% and 88% (P=0.11), respectively. In an exploratory analysis, progression-free and overall survival were markedly superior for PET-positive Deauville score 4 versus score 5 (P=0.0002 and P=0.001, respectively). Therefore, diffuse large B-cell lymphoma patients who are PET-positive after 4 cycles of R-CHOP-14 and who switched to R-ICE and 90Y-ibritumomab tiuxetan-BEAM achieved favorable survival outcomes similar to those for PET-negative R-CHOP-14-treated patients. Further studies are warranted to confirm these promising results. (Registered at: ACTRN12609001077257).
DOI: 10.3324/haematol.2016.154039
PubMed URL:
Type: Journal Article
Subjects: Antineoplastic Combined Chemotherapy Protocols
Lymphoma, Large B-Cell, Diffuse
Positron-Emission Tomography
Appears in Collections:Journal articles

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