R‐CHOP‐14 versus R‐CHOP‐14/CHASER for upfront autologous transplantation in diffuse large B‐cell lymphoma: JCOG0908 study

Autor: Ryo Tominaga, Koichiro Minauchi, Yasuo Morishima, Yoshitoyo Kagami, Kazuhito Yamamoto, Michihide Tokuhira, Satoko Morishima, Shigeru Kusumoto, Shigeo Nakamura, Taro Shibata, Kisato Nosaka, Hirokazu Nagai, Shinichiro Yoshida, Kensei Tobinai, Junya Kuroda, Youko Suehiro, Nobuhiko Yamauchi, Michinori Ogura, Yasushi Kubota, Kunihiro Tsukasaki, Kazuyuki Shimada, Dai Maruyama, Noriko Fukuhara, Yoshihiro Yakushijin, Akira Hangaishi, Hideki Tsujimura, Hirofumi Kobayashi, Yasushi Takamatsu, Yoshiko Inoue, Tomomitsu Hotta, Toshiki Uchida, Yoshitaka Imaizumi, Sachiko Suzuki
Rok vydání: 2020
Předmět:
Adult
Male
0301 basic medicine
Cancer Research
medicine.medical_specialty
Phases of clinical research
Transplantation
Autologous
Gastroenterology
Young Adult
03 medical and health sciences
0302 clinical medicine
Autologous stem-cell transplantation
International Prognostic Index
autologous stem‐cell transplantation
Clinical Research
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Humans
Autologous transplantation
Medicine
Cyclophosphamide
induction chemotherapy
Aged
business.industry
diffuse large B‐cell lymphoma
Hematopoietic Stem Cell Transplantation
Induction chemotherapy
General Medicine
Middle Aged
medicine.disease
Combined Modality Therapy
Progression-Free Survival
Transplantation
Regimen
030104 developmental biology
Oncology
Doxorubicin
Vincristine
030220 oncology & carcinogenesis
high‐dose chemotherapy
Prednisone
Original Article
Female
Lymphoma
Large B-Cell
Diffuse
Rituximab
business
Diffuse large B-cell lymphoma
JCOG‐LSG
Zdroj: Cancer Science
ISSN: 1349-7006
1347-9032
DOI: 10.1111/cas.14604
Popis: The efficiency of upfront consolidation with high‐dose chemotherapy/autologous stem‐cell transplantation (HDCT/ASCT) for newly diagnosed high‐risk diffuse large B‐cell lymphoma (DLBCL) may be influenced by induction chemotherapy. To select better induction chemotherapy regimens for HDCT/ASCT, a randomized phase II study was conducted in high‐risk DLBCL patients having an age‐adjusted International Prognostic Index (aaIPI) score of 2 or 3. As induction chemotherapy, 6 cycles of R‐CHOP‐14 (arm A) or 3 cycles of R‐CHOP‐14 followed by 3 cycles of CHASER (arm B) were planned, and patients who responded proceeded to HDCT with LEED and ASCT. The primary endpoint was 2‐y progression‐free survival (PFS), and the main secondary endpoints included overall survival, overall response rate, and adverse events (AEs). In total, 71 patients were enrolled. With a median follow‐up of 40.3 mo, 2‐y PFS in arms A and B were 68.6% (95% confidence interval [CI], 50.5%‐81.2%) and 66.7% (95% CI: 48.8%‐79.5%), respectively. Overall survival at 2 y in arms A and B was 74.3% (95% CI: 56.4%‐85.7%) and 83.3% (95% CI: 66.6%‐92.1%). Overall response rates were 82.9% in arm A and 69.4% in arm B. During induction chemotherapy, 45.7% and 75.0% of patients in arms A and B, respectively, had grade ≥ 3 non‐hematologic toxicities. One patient in arm A and 6 in arm B discontinued induction chemotherapy due to AEs. In conclusion, R‐CHOP‐14 showed higher 2‐y PFS and less toxicity compared with R‐CHOP‐14/CHASER in patients with high‐risk DLBCL, suggesting the former to be a more promising induction regimen for further investigations (UMIN‐CTR, UMIN000003823).
The efficiency of upfront consolidation with high‐dose chemotherapy/autologous stem‐cell transplantation (HDCT/ASCT) for newly diagnosed high‐risk diffuse large B‐cell lymphoma (DLBCL) may be influenced by induction chemotherapy. To select better induction chemotherapy regimens for HDCT/ASCT, a randomized phase II study was conducted in patients with high‐risk DLBCL who had an age‐adjusted International Prognostic Index (aaIPI) score of 2 or 3. R‐CHOP‐14 showed higher 2‐y PFS and less toxicity compared with R‐CHOP‐14/CHASER in patients with high‐risk DLBCL, suggesting the former to be a more promising induction regimen for further investigations.
Databáze: OpenAIRE
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