High-dose therapy followed by autologous stem-cell transplantation with and without rituximab for primary treatment of high-risk diffuse large B-cell lymphoma.

Glass, B; Ziepert, M; Reiser, M; Freund, M; Trümper, L; Metzner, B; Feller, A; Loeffler, M; Pfreundschuh, M; Schmitz, N; German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL); Feller, AC; Hansmann, ML; Müler-Hermelink, HK; Moeller, P; Parwaresch, R; Stein, H; Glass, B; Schmitz, N; Schnabel, K; Rübe, C; Loeffler, M; Ziepert, M; Mann, B; Schoenwiese, U; Martin Montanez, L; Roskothen, M; Keil, C; Kunert, M; Wicklein, B; Döken, B; Schmiegel, W; Vetter, H; Pflüer, K; Steinhauer, H; Trüper, L; Eimermacher, H; Schmitz, N; Balleisen, L; Pfreundschuh, M; Fauser, A; Link, H; Fischer, J; Kneba, M; Hallek, M; Wagner, T; Graeven, U; Peschel, C; Schlödorff, D; Lutz, L; Berdel, W; Metzner, B; Pasold, R; Freund, M; Gassmann, W; Heidemann, E; Mergenthaler, H; Köbel, C; Frickhofen, N; Wilms, K     «

Glass, B; Ziepert, M; Reiser, M; Freund, M; Trümper, L; Metzner, B; Feller, A; Loeffler, M; Pfreundschuh, M; Schmitz, N; German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL); Feller, AC; Hansmann, ML; Müler-Hermelink, HK; Moeller, P; Parwaresch, R; Stein, H; Glass, B; Schmitz, N; Schnabel, K; Rübe, C; Loeffler, M; Ziepert, M; Mann, B; Schoenwiese, U; Martin Montanez, L; Roskothen, M; Keil, C; Kunert, M; Wicklein, B; Döken, B; Schmiegel, W; Vetter, H; Pflüer, K; Steinhauer, H; Trüper, L; E...     »

We aimed to determine safety and efficacy of rituximab (R) in combination with repetitive high-dose therapy (HDT) as primary treatment for diffuse large B-cell lymphoma (DLBCL).Patients aged 18-60 years and elevated lactate dehydrogenase were treated with four cycles of MegaCHOEP and transplantation of autologous stem cells after cycles 2, 3 and 4. Rituximab (375 mg/m²) was given before each cycle and 12 and 33 days after start of the last cycle of chemotherapy. Sixty-four patients given R-MegaCHOEP were compared with 29 patients who had received identical treatment without rituximab.Overall survival (OS) and event-free survival (EFS) after 3 years were significantly improved in patients treated with R-MegaCHOEP (OS: 78.7% versus 55.0%, P = 0.045; EFS: 72.7% versus 47.2%, P = 0.013). In a Cox regression model adjusted for performance status and stage, relative risk of treatment failure was lower (relative risk 0.5, P = 0.041) and OS was better (relative risk 0.4, P = 0.054) for patients given R-MegaCHOEP. Grade 3/4 infections were more frequent in the R-MegaCHOEP group (18.5% versus 6.0%, P = 0.003).The addition of rituximab to MegaCHOEP significantly improved outcome in young patients with high-risk DLBCL. The higher incidence of grade 3/4 infections needs consideration when rituximab and HDT regimens are combined.     «

We aimed to determine safety and efficacy of rituximab (R) in combination with repetitive high-dose therapy (HDT) as primary treatment for diffuse large B-cell lymphoma (DLBCL).Patients aged 18-60 years and elevated lactate dehydrogenase were treated with four cycles of MegaCHOEP and transplantation of autologous stem cells after cycles 2, 3 and 4. Rituximab (375 mg/m²) was given before each cycle and 12 and 33 days after start of the last cycle of chemotherapy. Sixty-four patients given R-MegaC...     »