Haematologica (Aug 2011)

Survival impact of rituximab combined with ACVBP and upfront consolidation autotransplantation in high-risk diffuse large B-cell lymphoma for GELA

  • Olivier Fitoussi,
  • Karim Belhadj,
  • Nicolas Mounier,
  • Marie Parrens,
  • Hervé Tilly,
  • Gilles Salles,
  • Pierre Feugier,
  • Christophe Ferme,
  • Loic Ysebaert,
  • Jean Gabarre,
  • Raoul Herbrecht,
  • Maud Janvier,
  • Eric Van Den Neste,
  • Franck Morschhauser,
  • Olivier Casasnovas,
  • Hervé Ghesquieres,
  • Bruno Anglaret,
  • Sabine Brechignac,
  • Corinne Haioun,
  • Christian Gisselbrecht

DOI
https://doi.org/10.3324/haematol.2010.038109
Journal volume & issue
Vol. 96, no. 8

Abstract

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Background As rituximab combined with CHOP improves complete remission and overall survival in diffuse large B-cell lymphoma, intensified chemotherapy followed by autologous stem-cell transplantation has also been advocated for high-risk patients. The aim of this study was to establish whether or not combining rituximab with high-dose chemotherapy and auto-transplantation also benefits patient survival.Design and Methods The LNH2003-3 study was a phase II trial including diffuse large B-cell lymphoma patients with 2 or 3 International Prognostic Index factors. They received four cycles of intensive biweekly chemotherapy with rituximab, doxorubicine, cyclophosphamide, vindesine, bleomycine, prednisolone (R-ACVBP) followed by auto-transplantation in responding patients. Two hundred and nine patients under 60 years of age were included in the study and 155 responding patients underwent auto-transplantation. In addition, a case-control study was performed by matching (1:1) 181 patients treated with R-ACVBP with ACVBP patients not given rituximab but submitted to auto-transplantation from the previous LNH1998-3 trial.Results With a median follow up of 45 months, 4-year progression-free survival and overall survival were estimated at 76% (CI: 69–81) and 78% (CI: 72–83), respectively. There was no difference between patients with 2 or 3 International Prognostic Index factors. Four year progression-free survival was significantly higher in R-ACVBP than ACVBP patients (74% vs. 58%; P=0.0005). There was also a significant increase in 4-year overall survival (76% vs. 68%; P=0.0494).Conclusions In high-risk diffuse large B-cell lymphoma patients, treatment with R-ACVBP followed by auto-transplantation results in a 78% 4-year overall survival which should be compared to other approaches. (Clinicaltrials.gov identifier: NCT00144807)