Young patients with non-germinal center B-cell-like diffuse large B-cell lymphoma benefit from intensified chemotherapy with ACVBP plus rituximab compared with CHOP plus rituximab: analysis of data from the Groupe d'Etudes des Lymphomes de l'Adulte/lymphoma study association phase III trial LNH 03-2B
| Autor: | Hervé Tilly, Olivier Casasnovas, Nicolas Mounier, Francoise Berger, Catherine Thieblemont, Corinne Haioun, Marie-Christine Copin, Karen Leroy, Jean-Philippe Jais, Danielle Canioni, Philippe Gaulard, Christiane Copie-Bergman, Bertrand Coiffier, Franck Morschauser, Tony Petrella, Christian Recher, Gilles Salles, Fabrice Jardin, Thierry Jo Molina, Josette Brière, Bettina Fabiani, Christophe Fermé |
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| Rok vydání: | 2014 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty Vincristine Pathology Vindesine Prednisolone Kaplan-Meier Estimate CHOP Disease-Free Survival Proto-Oncogene Proteins c-myc Antibodies Monoclonal Murine-Derived Bleomycin International Prognostic Index Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Biomarkers Tumor Humans Cyclophosphamide Chemokine CCL2 Proportional Hazards Models business.industry Middle Aged BCL6 medicine.disease Immunohistochemistry Lymphoma DNA-Binding Proteins Treatment Outcome Doxorubicin Interferon Regulatory Factors Proto-Oncogene Proteins c-bcl-6 Prednisone Rituximab Female Neprilysin Immunotherapy Lymphoma Large B-Cell Diffuse Germinal center B-cell like diffuse large B-cell lymphoma business Algorithms medicine.drug |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 32(35) |
| ISSN: | 1527-7755 |
| Popis: | Purpose To determine whether any tumor biomarkers could account for the survival advantage observed in the LNH 03-2B trial among patients with diffuse large B-cell lymphoma (DLBCL) and low-intermediate risk according to the International Prognostic Index when treated with dose-intensive rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP) compared with standard rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisone (R-CHOP). Patients and Methods Using immunohistochemistry, expression of CD10, BCL6, MUM1, MYC, and BCL2 and coexpression of MYC/BCL2 were examined. The interaction effects between each biomarker and treatment arm on survival were studied in a restricted model and a full model incorporating clinical parameters. Results Among the 379 patients analyzed in the trial, 229 tumors were evaluable for germinal center B-cell–like (GCB)/non-GCB subclassification according to the Hans algorithm. Among all the biomarkers, only the interaction between the Hans algorithm and the treatment arm was significant for progression-free survival (PFS) and overall survival (OS) in univariable (PFS, P = .04; OS, P = .01) and multivariable (PFS, P = .03; OS, P = .01) analyses. Non-GCB tumors predicted worse PFS (hazard ratio [HR], 3.21; 95% CI, 1.29 to 8.00; P = .01) and OS (HR, 6.09; 95% CI, 1.37 to 27.03; P = .02) among patients treated with R-CHOP compared with patients who received R-ACVBP, whereas there were no significant survival differences between these regimens among patients with GCB tumors. Conclusion The survival benefit related to R-ACVBP over R-CHOP is at least partly linked to improved survival among patients with non-GCB DLBCL. Therefore, the Hans algorithm could be considered a theragnostic biomarker for selecting young patients with DLBCL who can benefit from an intensified R-ACVBP immunochemotherapy regimen. |
| Databáze: | OpenAIRE |
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