Oxaliplatin before autologous transplantation in combination with high-dose cytarabine and rituximab provides longer disease control than cisplatin or carboplatin in patients with mantle-cell lymphoma: results from the LyMA prospective trial.
Adult
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Carboplatin
/ therapeutic use
Cisplatin
Cytarabine
/ therapeutic use
Disease-Free Survival
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma, Mantle-Cell
/ drug therapy
Oxaliplatin
/ therapeutic use
Prospective Studies
Rituximab
/ therapeutic use
Transplantation, Autologous
Journal
Bone marrow transplantation
ISSN: 1476-5365
Titre abrégé: Bone Marrow Transplant
Pays: England
ID NLM: 8702459
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
07
10
2020
accepted:
10
12
2020
pubmed:
5
3
2021
medline:
27
7
2021
entrez:
4
3
2021
Statut:
ppublish
Résumé
LyMA trial has demonstrated the benefit of rituximab maintenance after autologous stem cell transplantation (ASCT) in previously untreated mantle-cell lymphoma patients (MCL). Induction consisted of four courses of R-DHAP (rituximab, dexamethasone, high-dose cytarabine, and platinum derivative). The platinum derivative (PD) choice was free: R-DHA-cisplatin, R-DHA-carboplatin, or R-DHA-oxaliplatin. We investigated the prognostic impact of each PD. PFS and OS calculated from inclusion and investigated in an intention-to-treat (ITT) (= 298) and per-protocol analyses (PP) (n = 227). R-DHACis, R-DHACa, or R-DHAOx were used at first cycle in 184, 76, and 38 patients, respectively. Overall, 71 patients (59 in the R-DHACis) required a change in PD, mainly because of PD toxicity. In ITT-analysis, PFS in the R-DHACis and R-DHACa groups were similar (4-year PFS of 65%), while R-DHAOx had a better PFS (4-year PFS of 65% versus 86.5%, respectively, HR = 0.44, p = 0.02). The 4-year OS was 92% for R-DHAOx versus 75.9% for R-DHACis/DHACa (HR = 0.37, p = 0.03). Similar results were yielded in the PP analysis. Low MIPI and R-DHAOx were independent favorable prognostic markers for both PFS (HR = 0.44, p = 0.035) and OS (HR = 0.36, p = 0.045). In vitro and in silico analyses confirmed that oxaliplatin has an anti-MCL cytotoxic effect that differs from that of other PD. R-DHAOx before ASCT provides better outcome in transplantation eligible young MCL patients.
Identifiants
pubmed: 33658645
doi: 10.1038/s41409-020-01198-2
pii: 10.1038/s41409-020-01198-2
doi:
Substances chimiques
Cytarabine
04079A1RDZ
Oxaliplatin
04ZR38536J
Rituximab
4F4X42SYQ6
Carboplatin
BG3F62OND5
Cisplatin
Q20Q21Q62J
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1700-1709Références
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