R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study
Por:
Martin, A, Conde, E, Arnan, M, Canales, MA, Deben, G, Sancho, JM, Andreu, R, Salar, A, Garcia-Sanchez, P, Vazquez, L, Nistal, S, Requena, MJ, Donato, EM, Gonzalez, JA, Leon, A, Ruiz, C, Grande, C, Gonzalez-Barca, E and Caballero, MD
Publicada:
1 dic 2008
Categoría:
Hematology
Resumen:
Background
The role of re-treatment with rituximab in aggressive B-cell lymphomas still needs to be defined. This study evaluated the influence of prior exposure to rituximab on response rates and survival in patients. with diffuse large B-cell lymphoma treated with rituximab plus etoposide, cytarabine, cisplatinum and methylprednisolone (R-ESHAP).
Design and Methods
We retrospectively analyzed 163 patients with relapsed or refractory diffuse large B-cell lymphoma who received R-ESHAP as salvage therapy with a curative purpose. Patients were divided into two groups according to whether rituximab had been administered(n=94, "R+" group) or not (n=69, "R-" group) prior to R-ESHAP
Results
Response rates were significantly higher in the R- group in the univariate but not in the multivariate analysis. In the analysis restricted to the R+ group, we observed very low complete remission and overall response rates in patients with primary refractory disease (8% and 33%, respectively), as compared to those in patients who were in first partial remission (41% and 86%) or who had relapsed disease (50% and 75%) (p<0.01 in both cases). Overall, 60% and 65% of patients in the R+ and R- groups, respectively, underwent stem-cell transplantation after the salvage therapy. With a median follow-up of 29 months (range, 6-84), patients in the R+ group had significantly worse progression-free survival (17% vs. 57% at 3 years, p<0.0001) and overall survival (38% v 67% at 3 years, p=0.0005) than patients in the R- group. Prior exposure to rituximab was also an independent adverse prognostic factor for both progression-free survival (RR: 2.0; 95% Cl: 1.2-3.3, p=0.008) and overall survival (RR: 2.2; 95% Cl: 1.3-3.9, p=0.004).
Conclusions
R-ESHAP was associated with a high response rate in patients who were not refractory to upfront rituximab-based chemotherapy. However, the survival outcome was poor for patients previously exposed to rituximab, as compared to in those who had not previously been treated with rituximab.
Filiaciones:
Martin, A:
Complejo Hosp Zamora, Dept Hematol, Zamora 49022, Spain
Conde, E:
Hosp Marques Valdecilla, Santander, Spain
Canales, MA:
Hosp La Paz, Madrid, Spain
Deben, G:
Hosp Juan Canalejo, La Coruna, Spain
:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Andreu, R:
Hosp Dr Peset, Valencia, Spain
Salar, A:
Hosp Mar, Barcelona, Spain
Garcia-Sanchez, P:
Hosp Clin Madrid, Madrid, Spain
Vazquez, L:
Hosp Univ Salamanca, Salamanca, Spain
Nistal, S:
Hosp Univ Getafe, Getafe, Spain
Requena, MJ:
Hosp Severo Ochoa, Leganes, Spain
Donato, EM:
Hosp Gen Castellon, Castellon de La Plana, Spain
Gonzalez, JA:
Hosp Virgen Puerto, Plasencia, Spain
Leon, A:
Hosp Gen Jerez, Jerez de la Frontera, Spain
Ruiz, C:
Hosp Carlos Haya, Malaga, Spain
Grande, C:
Hosp Doce Octubre, Madrid, Spain
Caballero, MD:
Hosp Univ Salamanca, Salamanca, Spain
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