Page 157 - 18F-FDG PET as biomarker in aggressive lymphoma; technical and clinical validation

Rituximab intensification during R-CHOP in DLBCL
Context
Key Objective
Diffuse large B-cell lymphoma (DLBCL) is a curable disease. However, 40% of patients are refractory to or relapse after treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Several single-arm phase II studies in elderly patients with DLBCL have explored variations of the rituximab schedule in combination with CHOP and have reported a better outcome for patients with poor prognosis. Our randomized study examined whether rituximab intensification during the first 4 cycles of 2-week R-CHOP could improve the outcome of untreated patients with DLBCL compared with standard 2-week R-CHOP.
Knowledge Generated
Intensification of rituximab during the first 4 cycles of 2-week R-CHOP did not improve complete remission rate, progression-free survival, or overall survival. Patients between ages 66 and 80 years experienced more neutropenia and infections during rituximab intensification.
Relevance
R-CHOP remains the standard treatment for DLBCL. Novel therapies are needed to improve the outcome of these patients.
Introduction
The overall survival (OS) of patients with diffuse large B-cell lymphoma (DLBCL) has improved significantly since the addition of rituximab to standard 3-week cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP-21) or dose-dense 2-week CHOP (R-CHOP-14) [1,2].No significant benefits have been shown for R-CHOP-14 versus R-CHOP-21, and these regimens are currently standard treatments worldwide [3,4]. However, approximately 40% of patients experience primary refractory disease or relapse, which is often fatal [5,6]. Therefore, further improvement of first-line therapy is needed.
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