Concurrent Rituximab with Dose-Dense MegaCEOP Chemotherapy and High Dose Mitoxantrone, Ara-C and Dexamethasone (MAD) Followed by BEAM and Autologous Stem Cell Transplantation (ASCT) Is Feasible and Effective in High Risk Diffuse Large B-Cell Lymphoma (B-DLCL): A Multicenter Pilot Study

Autor: Enrico Pogliani, Umberto Vitolo, Emanuele Angelucci, Isabella Palumbo, Enzo Pavone, Delia Rota-Scalabrini, Barbara Botto, Giuseppe Rossi, Carola Boccomini, Alessandro Levis, Anna Tonso, Maria Giuseppina Cabras, Francesco Di Vito, Annalisa Chiappella, Eugenio Gallo, Anna Marina Liberati, Flavia Salvi, Lisa Bonello, Alessandra Tucci
Rok vydání: 2004
Předmět:
Zdroj: Blood. 104:1321-1321
ISSN: 1528-0020
0006-4971
DOI: 10.1182/blood.v104.11.1321.1321
Popis: Introduction: the addition of Rituximab to standard chemotherapy CHOP improves the outcome of advanced stage B-DLCL, however pts at high risk continue to have a poor outcome. The combination of Rituximab with dose-dense and intensified chemotherapy is still poorly studied so far. Patients and methods: from January 2001 to June 2004, 92 previously untreated pts Results: Median age was 47 years (19–60); 6% were at LI risk (enrolled because of BM involvement), 53% at IH and 41% at H risk according to IPI; 27% had BM involvement and 80% LDH level >normal. So far, 72 pts who completed the treatment are evaluable for response and toxicity. Fifty-seven pts (79%) achieved a CR;one a PR (1.4%); ten pts (14%) progressed before (7 pts) or shortly after (3 pts) ASCT. Four pts (5.6%) died of infectious toxicities (2 bacterial sepsis and 2 pneumonia) which occurred during neutropenic period post MAD (3 pts) or after ASCT (1 pt). Sixteen pts did not completed the planned treatment because of disease progression before ASCT (7 pts) or inadequate PBSC yield (5 pts) or toxicity (4 pts). With a median follow-up of 2 yrs, only 2 pts relapsed. Two-yrs FFS and OS were: 72% and 77%. Fourteen pts developed infections (WHO>2): 2 interstitial pneumonia, 5 neutropenic Gram- and 2 Gram+ sepsis, 1 disseminated herpes zoster, 1 Ps. Aeruginosa and 1 Staph. aureus pneumonia, 1 bacterial pancreatitis and 1 perianal abscess. A molecular marker has been detected at diagnosis in 27 patients. So far, 12 PBSC harvest has been analyzed and 11/12 were PCR negative. Conclusions: this interim analysis suggests that the concurrent use of Rituximab with dose-dense and high dose chemotherapy followed by myeloablative therapy with ASCT support is effective to achieve a high CR and a high 2-yr FFS rate in a group of B-DLCL patients at poor prognosis. Furthermore, the addition of Rituximab during mobilitation procedure with R-MAD may allow to collect lymphoma-free PBSC harvest.
Databáze: OpenAIRE
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