Safety and efficacy of a dose-dense short-term therapy in patients with MYC-translocated aggressive lymphoma.


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
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

5811-5820

Informations 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.

Auteurs

Andrés J M Ferreri (AJM)

Lymphoma Unit, Department of Onco-Hematology, IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milano, Italy.

Piera Angelillo (P)

Lymphoma Unit, Department of Onco-Hematology, IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milano, Italy.

Federico Erbella (F)

Lymphoma Unit, Department of Onco-Hematology, IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milano, Italy.

Chiara Cattaneo (C)

Division of Hematology, Ospedali Civili di Brescia, Brescia; Italy.

Luisa Verga (L)

Division of Hematology, Azienda Ospedaliera San Gerardo, Monza, Italy.

Arben Lleshi (A)

Division of Medical Oncology and Immune-related tumors, IRCCS Centro di Riferimento Oncologico (CRO), Aviano (Pordenone), Italy.

Bernardino Allione (B)

A.O. Città della Salute e della Scienza - Le Molinette, Turin, Italy.

Maurilio Ponzoni (M)

Pathology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.
Vita-Salute San Raffaele University, Milano, Italy.

Fabio Facchetti (F)

Pathology Unit, Ospedali Civili di Brescia, Brescia; Italy.

Chiara Pagani (C)

Division of Hematology, Ospedali Civili di Brescia, Brescia; Italy.

Marco Foppoli (M)

Lymphoma Unit, Department of Onco-Hematology, IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milano, Italy.

Lorenza Pecciarini (L)

Pathology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy.

Marianna Sassone (M)

Lymphoma Unit, Department of Onco-Hematology, IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milano, Italy.

Sara Steffanoni (S)

Lymphoma Unit, Department of Onco-Hematology, IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milano, Italy.

Elena Flospergher (E)

Lymphoma Unit, Department of Onco-Hematology, IRCCS (Istituto di Ricerca e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milano, Italy.

Giuseppe Rossi (G)

Division of Hematology, Ospedali Civili di Brescia, Brescia; Italy.

Michele Spina (M)

Division of Medical Oncology and Immune-related tumors, IRCCS Centro di Riferimento Oncologico (CRO), Aviano (Pordenone), Italy.

Alessandro Re (A)

Division of Hematology, Ospedali Civili di Brescia, Brescia; Italy.

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Classifications MeSH