Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16726
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
Austin 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)
Affiliation: Department of Haematology, Prince of Wales Hospital and University of NSW, Randwick, NSW, Australia
The University of Queensland Diamantina Institute Woolloongabba, Brisbane, QLD, Australia
Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
Department of Haematology, Repatriation General Hospital Concord and University of Sydney, NSW, Australia
WriteSource Medical Pty Ltd., Lane Cove, NSW, Australia
Nepean Cancer Care Centre, Nepean Hospital, Nepean, NSW, Australia
Department of Haematology, Westmead Hospital, NSW, Australia
Department of Haematology, St George Hospital, Kogarah, NSW, Australia
Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
Department of Haematology, Royal North Shore Hospital, St Leonard's, NSW, Australia
Olivia Newton John Cancer & Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
Department of Haematology, Austin Health, Heidelberg, Victoria, Australia
Department of Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia
Department of Haematology, St Vincent's Hospital Darlinghurst, NSW, Australia
Department of Haematology, Royal Melbourne Hospital, Parkville, Victoria, Australia
Department of Haematology, The Queen Elizabeth Hospital, SA, Australia
Department of Haematology, St Vincent's Hospital, Melbourne, Victoria, Australia
Ballarat Oncology and Haematology Service and Fiona Elsey Cancer Research Institute, Ballarat, Victoria, Australia
Department of Haematology, Liverpool Hospital, Liverpool, NSW, Australia
Department of Haematology, Wollongong Hospital, Wollongong, NSW, Australia
Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
Department of Haematology, Peter MacCallum Cancer Centre East Melbourne and University of Melbourne, Parkville, Victoria, Australia
Department of Cancer Imaging, Peter MacCallum Cancer Centre East Melbourne, Victoria, Australia
Issue Date: Feb-2017
metadata.dc.date: 2016-11-10
Publication information: 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).
URI: http://ahro.austin.org.au/austinjspui/handle/1/16726
DOI: 10.3324/haematol.2016.154039
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/28143954
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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