Safety and efficacy of a dose-dense short-term therapy in patients with MYC-translocated aggressive lymphoma.
Humans
Rituximab
/ therapeutic use
Vincristine
/ adverse effects
Etoposide
/ adverse effects
Hematopoietic Stem Cell Transplantation
Retrospective Studies
In Situ Hybridization, Fluorescence
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Transplantation, Autologous
COVID-19
Cyclophosphamide
/ adverse effects
Prednisone
/ therapeutic use
Cytarabine
/ adverse effects
Burkitt Lymphoma
/ drug therapy
Doxorubicin
/ adverse effects
Lymphoma, B-Cell
/ drug therapy
Lymphoma
/ drug therapy
HIV Infections
/ drug therapy
Journal
Blood advances
ISSN: 2473-9537
Titre abrégé: Blood Adv
Pays: United States
ID NLM: 101698425
Informations de publication
Date de publication:
22 11 2022
22 11 2022
Historique:
accepted:
03
05
2022
received:
03
03
2022
pubmed:
18
5
2022
medline:
16
11
2022
entrez:
17
5
2022
Statut:
ppublish
Résumé
Patients with aggressive B-cell lymphoma and MYC rearrangement at fluorescence in situ hybridization exhibit poor outcome after R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). In the last decade, 68 patients with Burkitt lymphoma ([BL] n = 46) or high-grade B-cell lymphoma ([HGBCL] single, double, or triple hit; n = 22) were treated with a dose-dense, short-term therapy termed "CARMEN regimen" at 5 Italian centers. Forty-six (68%) patients were HIV+. CARMEN included a 36-day induction with sequential, single weekly doses of cyclophosphamide, vincristine, rituximab, methotrexate, etoposide, and doxorubicin plus intrathecal chemotherapy, followed by high-dose-cytarabine-based consolidation. Patients who did not achieve complete remission (CR) after induction received BEAM (carmustina, etoposide, cytarabine, melfalan)-conditioned autologous stem cell transplantation (ASCT) after consolidation. Sixty-one (90%) patients completed induction, and 59 (87%) completed consolidation. Seventeen patients received ASCT. Grade 4 hematological toxicity was common but did not cause treatment discontinuation; grade 4 nonhematological toxicity was recorded in 11 (16%) patients, with grade 4 infections in 6 (9%). Six (9%) patients died of toxicity (sepsis in 4, COVID-19, acute respiratory distress syndrome). CR rate after the whole treatment was 73% (95% confidence interval [CI], 55% to 91%) for patients with HGBCL and 78% (95% CI, 66% to 90%) for patients with BL. At a median follow-up of 65 (interquartile range, 40-109) months, 48 patients remain event free, with a 5-year progression-free survival of 63% (95% CI, 58% to 68%) for HGBCL and 72% (95% CI, 71% to 73%) for BL, with a 5-year overall survival (OS) of 63% (95% CI, 58% to 68%) and 76% (95% CI, 75% to 77%), respectively. HIV seropositivity did not have a detrimental effect on outcome. This retrospective study shows that CARMEN is a safe and active regimen both in HIV-negative and -positive patients with MYC-rearranged lymphomas. Encouraging survival figures, attained with a single dose of doxorubicin and cyclophosphamide, deserve further investigation in HGBCL and other aggressive lymphomas.
Identifiants
pubmed: 35580327
pii: 485287
doi: 10.1182/bloodadvances.2022007475
pmc: PMC9641166
doi:
Substances chimiques
Rituximab
4F4X42SYQ6
Vincristine
5J49Q6B70F
Etoposide
6PLQ3CP4P3
Antibodies, Monoclonal, Murine-Derived
0
Cyclophosphamide
8N3DW7272P
Prednisone
VB0R961HZT
Cytarabine
04079A1RDZ
Doxorubicin
80168379AG
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5811-5820Informations de copyright
© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.