Radiotherapy in younger patients with advanced aggressive B-cell lymphoma-long-term results from the phase 3 R-MegaCHOEP trial.

Autor: Oertel M; Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany., Ziepert M; Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany., Frontzek F; Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada.; Department of Medicine A for Hematology, Oncology, and Pulmonology, University Hospital Muenster, Muenster, Germany., Nacke N; Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany., Altmann B; Institute for Medical Informatics, Statistics, and Epidemiology, University of Leipzig, Leipzig, Germany., Nickelsen M; Oncology Lerchenfeld, Hamburg, Germany., Glass B; Clinic for Hematology, Oncology, Tumor Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany., Poeschel V; Department of Hematology, Oncology and Rheumatology, Saarland University Medical School, Homburg, Saar, Germany., Ruebe C; Department of Radiation Oncology, Saarland University Medical School, Homburg, Saar, Germany., Lenz G; Department of Medicine A for Hematology, Oncology, and Pulmonology, University Hospital Muenster, Muenster, Germany., Schmitz N; Department of Medicine A for Hematology, Oncology, and Pulmonology, University Hospital Muenster, Muenster, Germany., Eich HT; Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany. Hans.eich@ukmuenster.de.
Jazyk: angličtina
Zdroj: Leukemia [Leukemia] 2024 May; Vol. 38 (5), pp. 1099-1106. Date of Electronic Publication: 2024 Mar 27.
DOI: 10.1038/s41375-024-02231-9
Abstrakt: The role of consolidative radiotherapy (RT) for patients with aggressive B-cell lymphoma has not been fully elucidated. The R-MegaCHOEP trial investigated the use of high-dose chemotherapy and rituximab with subsequent autologous stem cell transplantations compared to conventional immunochemotherapy (R-CHOEP) for high-risk patients up to 60 years. The study protocol included RT for patients with bulky (maximum diameter ≥7.5 cm) or extranodal disease. Two-hundred sixty-one patients were analyzed, 120 of whom underwent RT. The most frequently irradiated regions were mediastinum (n = 50) and paraaortic (n = 27). Median RT dose was 36 Gray in median fractions of 1.8 Gray. Acute toxicities were mostly mild to moderate, with only 24 and 8 grade 3 and 4 toxicities reported during RT. Patients with bulky disease who received RT showed significantly better 10-year EFS, PFS and OS (EFS: 64% vs. 35%; p < 0.001; PFS 68% vs. 47%; p = 0.003; OS: 72% vs. 59%; p = 0.011). There was no significant increase in secondary malignancies with the use of RT. RT administered for consolidation of bulky disease after immunochemotherapy improved the prognosis of young high-risk patients with aggressive B-cell lymphoma and should be considered part of first-line therapy. The trial was registered with ClinicalTrials.gov, number NCT00129090.
(© 2024. The Author(s).)
Databáze: MEDLINE
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