Outcomes of rituximab-BEAM versus BEAM conditioning regimen in patients with diffuse large B cell lymphoma undergoing autologous transplantation.
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
/ administration & dosage
Carmustine
/ administration & dosage
Cohort Studies
Cytarabine
/ administration & dosage
Etoposide
/ administration & dosage
Female
Hematopoietic Stem Cell Transplantation
/ methods
Humans
Lymphoma, Large B-Cell, Diffuse
/ therapy
Male
Melphalan
/ administration & dosage
Middle Aged
Multivariate Analysis
Registries
Rituximab
/ administration & dosage
Survival Analysis
Transplantation Conditioning
Transplantation, Autologous
Treatment Failure
Treatment Outcome
Young Adult
BEAM
autologous transplantation
chemoimmunotherapy
diffuse large B cell lymphoma
rituximab
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
15 05 2020
15 05 2020
Historique:
received:
26
11
2019
revised:
31
12
2019
accepted:
08
01
2020
pubmed:
13
2
2020
medline:
15
1
2021
entrez:
13
2
2020
Statut:
ppublish
Résumé
Although rituximab-based high-dose therapy is frequently used in diffuse large B cell lymphoma (DLBCL) patients undergoing autologous hematopoietic cell transplantation (auto-HCT), data supporting the benefits are not available. Herein, we report the impact of rituximab-based conditioning on auto-HCT outcomes in patients who have DLBCL. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, 862 adult DLBCL patients undergoing auto-HCT between 2003 and 2017 using BEAM (BCNU, etoposide, cytarabine, melphalan) conditioning regimen were included. All patients received frontline rituximab-containing chemoimmunotherapy and had chemosensitive disease pre-HCT. Early chemoimmunotherapy failure was defined as not achieving complete remission (CR) after frontline chemoimmunotherapy or relapse within 1 year of initial diagnosis. The primary outcome was overall survival (OS). The study cohort was divided into 2 groups: BEAM (n = 667) and R-BEAM (n = 195). On multivariate analysis, no significant difference was seen in OS (P = .83) or progression-free survival (PFS) (P = .61) across the 2 cohorts. No significant association between the use of rituximab and risk of relapse (P = .15) or nonrelapse mortality (P = .12) was observed. Variables independently associated with lower OS included older age at auto-HCT (P < .001), absence of CR at auto-HCT (P < .001) and early chemoimmunotherapy failure (P < .001). Older age (P < .0002) and non-CR pre-HCT (P < .0001) were also associated with inferior PFS. There was no significant difference in early infectious complications between the 2 cohorts. In this large registry analysis of DLBCL patients undergoing auto-HCT, the addition of rituximab to the BEAM conditioning regimen had no impact on transplantation outcomes. Older age, absence of CR pre auto-HCT, and early chemoimmunotherapy failure were associated with inferior survival.
Sections du résumé
BACKGROUND
Although rituximab-based high-dose therapy is frequently used in diffuse large B cell lymphoma (DLBCL) patients undergoing autologous hematopoietic cell transplantation (auto-HCT), data supporting the benefits are not available. Herein, we report the impact of rituximab-based conditioning on auto-HCT outcomes in patients who have DLBCL.
METHODS
Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, 862 adult DLBCL patients undergoing auto-HCT between 2003 and 2017 using BEAM (BCNU, etoposide, cytarabine, melphalan) conditioning regimen were included. All patients received frontline rituximab-containing chemoimmunotherapy and had chemosensitive disease pre-HCT. Early chemoimmunotherapy failure was defined as not achieving complete remission (CR) after frontline chemoimmunotherapy or relapse within 1 year of initial diagnosis. The primary outcome was overall survival (OS).
RESULTS
The study cohort was divided into 2 groups: BEAM (n = 667) and R-BEAM (n = 195). On multivariate analysis, no significant difference was seen in OS (P = .83) or progression-free survival (PFS) (P = .61) across the 2 cohorts. No significant association between the use of rituximab and risk of relapse (P = .15) or nonrelapse mortality (P = .12) was observed. Variables independently associated with lower OS included older age at auto-HCT (P < .001), absence of CR at auto-HCT (P < .001) and early chemoimmunotherapy failure (P < .001). Older age (P < .0002) and non-CR pre-HCT (P < .0001) were also associated with inferior PFS. There was no significant difference in early infectious complications between the 2 cohorts.
CONCLUSION
In this large registry analysis of DLBCL patients undergoing auto-HCT, the addition of rituximab to the BEAM conditioning regimen had no impact on transplantation outcomes. Older age, absence of CR pre auto-HCT, and early chemoimmunotherapy failure were associated with inferior survival.
Identifiants
pubmed: 32049359
doi: 10.1002/cncr.32752
pmc: PMC7190439
mid: NIHMS1552829
doi:
Substances chimiques
Cytarabine
04079A1RDZ
Rituximab
4F4X42SYQ6
Etoposide
6PLQ3CP4P3
Melphalan
Q41OR9510P
Carmustine
U68WG3173Y
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2279-2287Subventions
Organisme : NIAID NIH HHS
ID : U01 AI126612
Pays : United States
Organisme : NHLBI NIH HHS
ID : R21 HL140314
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA231141
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA215134
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL129472
Pays : United States
Organisme : NIAID NIH HHS
ID : U01 AI069197
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA152108
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA076518
Pays : United States
Organisme : NHLBI NIH HHS
ID : U24 HL138660
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL128568
Pays : United States
Organisme : HRSA HHS
ID : HHSH250201700006C
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL130388
Pays : United States
Organisme : NCI NIH HHS
ID : P01 CA111412
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI128775
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA218285
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL131731
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL126589
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL150232
Pays : United States
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2020 American Cancer Society.
Références
J Clin Oncol. 2008 Jul 1;26(19):3166-75
pubmed: 18490650
Am J Hematol. 2017 Feb;92(2):161-170
pubmed: 27880984
J Clin Oncol. 2014 Sep 20;32(27):3059-68
pubmed: 25113753
J Hematol Oncol. 2017 Jun 12;10(1):117
pubmed: 28606176
J Clin Oncol. 2005 Jun 20;23(18):4117-26
pubmed: 15867204
Bone Marrow Transplant. 2002 May;29(9):769-75
pubmed: 12040475
N Engl J Med. 2002 Jan 24;346(4):235-42
pubmed: 11807147
Lancet Oncol. 2011 Oct;12(11):1013-22
pubmed: 21940214
Lancet Oncol. 2008 Feb;9(2):105-16
pubmed: 18226581
J Clin Oncol. 2007 Feb 10;25(5):579-86
pubmed: 17242396
Biol Blood Marrow Transplant. 2014 Nov;20(11):1729-36
pubmed: 25008330
J Clin Oncol. 2010 Sep 20;28(27):4184-90
pubmed: 20660832
JAMA Oncol. 2019 May 1;5(5):715-722
pubmed: 30816957
Lifetime Data Anal. 1995;1(2):145-56; discussion 157-9
pubmed: 9385097
Blood. 2008 Jun 15;111(12):5530-6
pubmed: 18411419
Blood. 2008 Jan 15;111(2):537-43
pubmed: 17971487
Biol Blood Marrow Transplant. 2018 Jun;24(6):1163-1171
pubmed: 29242111
J Clin Oncol. 2013 May 1;31(13):1662-8
pubmed: 23478060
Br J Haematol. 2017 Feb;176(4):591-599
pubmed: 27982423
Biol Blood Marrow Transplant. 2000;6(6):628-32
pubmed: 11128813
Biol Blood Marrow Transplant. 2013 Sep;19(9):1288-300
pubmed: 23618718