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Oertel M, Ziepert M, Nacke N, Frontzek F, Nickelsen M, Glass B, Poeschel V, Rube C, Lenz G, Schmitz N, Eich HTT. Radiotherapy in Young, High-Risk Patients with Aggressive B-cell Lymphoma: Long-Term Results from the Open-Label, Randomized, Phase 3 R-MegaCHOEP Trial. Int J Radiat Oncol Biol Phys 2023; 117:S63. [PMID: 37784542 DOI: 10.1016/j.ijrobp.2023.06.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The role of consolidative radiotherapy (RT) for young (< 60 years), high-risk patients with aggressive B-cell lymphoma is discussed. The R-MegaCHOEP trial investigated the use of high-dose chemotherapy and rituximab with subsequent autologous stem cell transplantation compared to conventional R-CHOEP immunochemotherapy for patients up to 60 years1,2. Despite no prognostic difference between treatment arms even after 10-year follow-up, excellent long-term results were achieved. The presented work represents a detailed RT-analysis providing long-term data on efficacy and side-effects. MATERIALS/METHODS The 10-year follow-up dataset of the R-MegaCHOEP trial with a median follow-up of 81.1 months (range 0.6-175.9 months) was used for this analysis. Indications for consolidative RT were extralymphatic involvement or bulky disease (maximum diameter ≥ 7.5 cm). Additionally, RT could be administered because of insufficient response at end of therapy as evaluated by CT scan. RESULTS Overall, 261 patients were analyzed, 120 of whom underwent RT. Patients with RT were predominantly male (65.8 %), had an age-adjusted IPI of 2 (75 %), an elevated LDH (96.7 %) and showed an ECOG-Score of 0-1 (65 %). Bulky disease was present in 103/120 patients in the RT-arm with a bulk size of 7.5-20.0 cm (median: 11 cm) and was located predominantly in the mediastinal (44), paraaortal (17) and mesenteric (13) regions. The most frequently irradiated regions were the mediastinal (50), paraaortic (27) and mesenteric (15) regions. Median RT dose was 36 Gray in median fractions of 1.8 Gray. Toxicities were generally mild to moderate with 24 and 8 grade 3 and 4 toxicities reported during RT. During long-term follow-up, 23 secondary malignancies occurred, with RT being no significant contributing risk factor (p = 0.188). Analysis of the overall study population showed that patients with RT had an improved event-free survival (EFS; 63.9 % vs. 46.0 %; p<0.001) and progression-free survival (PFS; 67.2 % vs. 54.1 %; p = 0.025) but not overall survival (OS; 72.8 % vs. 65.9 %; p = 0.132) in comparison to non-irradiated patients after 10 years. Considering only those patients with RT after a complete remission/unconfirmed complete remission after systemic therapy, a significantly improved EFS (66.4 % vs. 46.0 %; p = 0.006), but not PFS and OS, was shown (PFS: p = 0.054; OS: p = 0.222). For patients with bulky disease, RT resulted in a significantly better outcome (10-year EFS: 64.4 % vs. 34.5 %; p<0.001; 10-year PFS: 68.3 % vs. 47.4 %; p = 0.003; 10-year OS: 71.5 % vs. 59.4 %; p = 0.011), when compared to patients without RT. For patients with extralymphatic involvement, RT improved EFS (10-year EFS: 61.7 % vs. 51.1 %; p = 0.017), but not PFS or OS (PFS: p = 0.068; OS: p = 0.305). CONCLUSION RT improved outcome in young, high-risk patients with aggressive B-cell lymphoma and bulky disease. TRIAL REGISTRATION NUMBER NCT00129090. LITERATURE 1 Lancet Oncol 2012;13(12):1250-1259. 2 Lancet Haematol 2021;8(4):e267-e277.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - M Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - N Nacke
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - F Frontzek
- Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, Muenster, Germany
| | | | - B Glass
- Clinic for Haematology, Oncology, Tumour Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - V Poeschel
- Saarland University Medical School, Homburg, Germany
| | - C Rube
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - G Lenz
- Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, Muenster, Germany
| | - N Schmitz
- Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, Muenster, Germany
| | - H T T Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
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2
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Croci GA, Au-Yeung RKH, Reinke S, Staiger AM, Koch K, Oschlies I, Richter J, Poeschel V, Held G, Loeffler M, Trümper L, Rosenwald A, Ott G, Spang R, Altmann B, Ziepert M, Klapper W. SPARC-positive macrophages are the superior prognostic factor in the microenvironment of diffuse large B-cell lymphoma and independent of MYC rearrangement and double-/triple-hit status. Ann Oncol 2021; 32:1400-1409. [PMID: 34438040 DOI: 10.1016/j.annonc.2021.08.1991] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with respect to outcome. Features of the tumor microenvironment (TME) are associated with prognosis when assessed by gene expression profiling. However, it is uncertain whether assessment of the microenvironment can add prognostic information to the most relevant and clinically well-established molecular subgroups when analyzed by immunohistochemistry (IHC). PATIENTS AND METHODS We carried out a histopathologic analysis of biomarkers related to TME in a very large cohort (n = 455) of DLBCL treated in prospective trials and correlated with clinicopathologic and molecular data, including chromosomal rearrangements and gene expression profiles for cell-of-origin and TME. RESULTS The content of PD1+, FoxP3+ and CD8+, as well as vessel density, was not associated with outcome. However, we found a low content of CD68+ macrophages to be associated with inferior progression-free survival (PFS) and overall survival (OS; P = 0.023 and 0.040, respectively) at both univariable and multivariable analyses, adjusted for the factors of the International Prognostic Index (IPI), MYC break and BCL2/MYC and BCL6/MYC double-hit status. The subgroup of PDL1+ macrophages was not associated with survival. Instead, secreted protein acidic and cysteine rich (SPARC)-positive macrophages were identified as the subtype of macrophages most associated with survival. SPARC-positive macrophages and stromal cells directly correlated with favorable PFS and OS (both, P[log rank] <0.001, P[trend] < 0.001). The association of SPARC with prognosis was independent of the factors of the IPI, MYC double-/triple-hit status, Bcl2/c-myc double expression, cell-of-origin subtype and a recently published gene expression signature [lymphoma-associated macrophage interaction signature (LAMIS)]. CONCLUSIONS SPARC expression in the TME detected by a single IHC staining with fair-to-good interobserver reproducibility is a powerful prognostic parameter. Thus SPARC expression is a strong candidate for risk assessment in DLBCL in daily practice.
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Affiliation(s)
- G A Croci
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - R K H Au-Yeung
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - S Reinke
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tübingen, Germany
| | - K Koch
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - I Oschlies
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Richter
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - V Poeschel
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - G Held
- DSHNHL Studiensekretariat, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - M Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - L Trümper
- Department of Hematology and Oncology, Georg-August Universität, Göttingen, Germany
| | - A Rosenwald
- Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken (CCCMF), Würzburg, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tübingen, Germany
| | - R Spang
- Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - B Altmann
- DSHNHL Studiensekretariat, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - M Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - W Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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3
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Thurner L, Bewarder M, Fadle N, Regitz E, Poeschel V, Ziepert M, Schuck R, Altmeyer S, Kemele M, Bock T, Schormann C, Walter S, Szczepanowski M, Klapper W, Monoranu C, Rosenwald A, Moeller P, Kim Y, Buslei R, Kaddu-Mulindwa D, Neumann F, Roemer K, Bohle R, Illerhaus G, Schorb E, Schaefer H, Hansmann M, Hartmann S, Held G, Stilgenbauer S, Murawski N, Pfreundschuh M, Preuss K. SAMD14/NEURABIN-I AS BCR-ANTIGENS OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.9_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- L. Thurner
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - M. Bewarder
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - N. Fadle
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - E. Regitz
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - V. Poeschel
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - M. Ziepert
- Universität Leipzig; Institute for Medical Informatics, Statistics, and Epidemiology; Leipzig Germany
| | - R. Schuck
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - S. Altmeyer
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - M. Kemele
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - T. Bock
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - C. Schormann
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - S. Walter
- Saarland Medical School; Department of Neurology; Homburg/Saar Germany
| | - M. Szczepanowski
- University of Kiel; Institute of Pathology, Hematopathology Section and Lymph Node Registry; Kiel Germany
| | - W. Klapper
- University of Kiel; Institute of Pathology, Hematopathology Section and Lymph Node Registry; Kiel Germany
| | - C. Monoranu
- University of Würzburg; Institute of Pathology and Neuropathology; Würzburg Germany
| | - A. Rosenwald
- University of Würzburg; Institute of Pathology and Neuropathology; Würzburg Germany
| | - P. Moeller
- University of Ulm; Department of Pathology; Ulm Germany
| | - Y. Kim
- Saarland Medical school; Department of pathology; Homburg/Saar Germany
| | - R. Buslei
- SozialStiftung Bamberg; Institute of Pathology; Bamberg Germany
| | - D. Kaddu-Mulindwa
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - F. Neumann
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - K. Roemer
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - R. Bohle
- Saarland Medical school; Department of pathology; Homburg/Saar Germany
| | - G. Illerhaus
- Klinikum Stuttgart; Department Hematology and Oncology; Stuttgart Germany
| | - E. Schorb
- University Medical Center Freiburg; Department of Hematology and Oncology; Freiburg Germany
| | - H. Schaefer
- University Medical Center Freiburg; Department of Hematology and Oncology; Freiburg Germany
| | - M.L. Hansmann
- Goethe University Frankfurt; Senckenberg Institute of Pathology; Frankfurt Germany
| | - S. Hartmann
- Goethe University Frankfurt; Senckenberg Institute of Pathology; Frankfurt Germany
| | - G. Held
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - S. Stilgenbauer
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - N. Murawski
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - M. Pfreundschuh
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
| | - K.D. Preuss
- Saarland Medical School; Internal Medicine I, José Carreras Center; Homburg/Saar Germany
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4
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Çağlayan Ç, Dixon J, Salles G, Wall A, Schmitz N, Cunningham D, Poeschel V, Seymour J, Jaeger U, Habermann T, Merli F, Haioun C, Tilly H, Ghesiquieres H, Ziepert M, Flament J, Shi Q, Flowers C. THE CLINICAL COURSE OF DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) OVER TIME: A MULTISTATE SURVIVAL ANALYSIS USING META-DATA FROM 13 FIRST-LINE RANDOMIZED TRIALS. Hematol Oncol 2019. [DOI: 10.1002/hon.56_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ç. Çağlayan
- Industrial and Systems Engineering; Georgia Institute of Technology; Atlanta GA United States
| | - J.G. Dixon
- Department of Health Sciences Research; Mayo Clinic; Rochester MN United States
| | - G. Salles
- Hematology; Hospices Civils de Lyon; Lyon France
| | - A. Wall
- Department of Health Sciences Research; Mayo Clinic; Rochester MN United States
| | - N. Schmitz
- Hematology and Oncology; University Hospital Muenster; Muenster Germany
| | - D. Cunningham
- Department of Medicine; The Royal Marsden Hospital; Sutton United Kingdom
| | - V. Poeschel
- Medical School; Saarland University; Homburg Germany
| | - J. Seymour
- Clinical Research; Integrated Haematology, Peter MacCallum Cancer Centre; Melbourne Australia
| | - U. Jaeger
- Department of Medicine I; Medical University of Vienna; Vienna Austria
| | - T. Habermann
- Cancer Center; Hematology, Mayo Clinic; Rochester MN United States
| | - F. Merli
- Hematology; AUSL-IRCCS; Reggio Emilia Italy
| | - C. Haioun
- Unite Hemopathies Lymphoides; Hopital Henri Mondor; Creteil France
| | - H. Tilly
- Hématologie; Centre Henri-Becquerel; Rouen France
| | - H. Ghesiquieres
- Service d'Hématologie; Centre Hospitalier Lyon-Sud, Pierre Bénite CEDEX; France
| | - M. Ziepert
- Institut für Medizinische Informatik; Statistik und Epidemiologie, Universität Leipzig; Leipzig Germany
| | - J. Flament
- Medicine and Biology; Celgene Corporation; Boudry Switzerland
| | - Q. Shi
- Department of Health Sciences Research; Mayo Clinic; Rochester MN United States
| | - C. Flowers
- Winship Cancer Institute; Emory University; Atlanta GA United States
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5
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Pfreundschuh M, Christofyllakis K, Altmann B, Ziepert M, Haenel M, Viardot A, Neubauer A, Held G, Truemper L, Dreyling M, Kanz L, Hallek M, Schmitz N, Heintges T, Kölbel C, Buecker A, Ruebe C, Hellwig D, Berdel C, Poeschel V, Murawski N. RADIOTHERAPY TO BULKY DISEASE PET-NEGATIVE AFTER IMMUNOCHEMOTHERAPY CAN BE SPARED IN ELDERLY DLBCL PATIENTS: RESULTS OF a PLANNED INTERIM ANALYSIS OF THE FIRST 187 PATIENTS WITH BULKY DISEASE TREATED IN THE OPTIMAL > 60 STUDY OF THE DSHNHL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- M. Pfreundschuh
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | | | - B. Altmann
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Ziepert
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Haenel
- Internal Medicine III; Chemnitz Hospital; Chemnitz Germany
| | - A. Viardot
- Internal Medicine III; University Hospital Ulm; Ulm Germany
| | - A. Neubauer
- Hematology/Oncology; University Hospital Marburg; Marburg Germany
| | - G. Held
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - L. Truemper
- Department of Internal Medicine; University Hospital Goettingen; Goettingen Germany
| | - M. Dreyling
- Department for Internal Medicine 3; University Hospital Muenchen - Großhadern; Muenchen Germany
| | - L. Kanz
- Hematology/Oncology; University Hospital Tuebingen; Tuebingen Germany
| | - M. Hallek
- Internal Medicine I; University Hospital Koeln; Koeln Germany
| | - N. Schmitz
- Hematology; ASKLEPIOS Clinic Hamburg; Hamburg Germany
| | - T. Heintges
- Internal Medicine II; Lukaskrankenhaus Neuss; Neuss Germany
| | - C. Kölbel
- Internal Medicine I, Krankenhaus der Barmherzigen Brüder Trier; Trier Germany
| | - A. Buecker
- Department for Radiology; Saarland University Hospital; Homburg Germany
| | - C. Ruebe
- Department for Radiotherapy; Saarland University Hospital; Homburg Germany
| | - D. Hellwig
- Department for Nuclearmedicine; University Hospital Regensburg; Regensburg Germany
| | - C. Berdel
- Department for Radiotherapy; Saarland University Hospital; Homburg Germany
| | - V. Poeschel
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - N. Murawski
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
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Murawski N, Amam J, Altmann B, Ziepert M, Haenel M, Viardot A, Neubauer A, Held G, Truemper L, Dreyling M, Kanz L, Hallek M, Schmitz N, Heintges T, Koelbel C, Poeschel V, Pfreundschuh M. ANTI-INFECTIVE PROPHYLAXIS WITH ACICLOVIR AND COTRIMOXAZOLE SIGNIFICANTLY REDUCES THE RATE OF INFECTIONS AND THERAPY-ASSOCIATED DEATHS IN ELDERLY PATIENTS WITH DLBCL UNDERGOING R-CHOP IMMUNOCHEMOTHERAPY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- N. Murawski
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - J. Amam
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - B. Altmann
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Ziepert
- IMISE; University of Leipzig; Leipzig Germany
| | - M. Haenel
- Internal Medicine III; Chemnitz Hospital; Chemnitz Germany
| | - A. Viardot
- Internal Medicine III; University Hospital Ulm; Ulm Germany
| | - A. Neubauer
- Hematology/Oncology; University Hospital Marburg; Marburg Germany
| | - G. Held
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - L. Truemper
- Department of Internal Medicine; University Hospital; Goettingen Germany
| | - M. Dreyling
- Department for Internal Medicine III; University Hospital Großhadern; Muenchen Germany
| | - L. Kanz
- Hematology/Oncology; University Hospital; Tuebingen Germany
| | - M. Hallek
- Internal Medicine I; University Hospital; Koeln Germany
| | - N. Schmitz
- Hematology, ASKLEPIOS clinic; Hamburg Germany
| | - T. Heintges
- Internal Medicine III, Lukaskrankenhaus; Neuss Germany
| | - C. Koelbel
- Internal Medicine I, Krankenhaus der Barmherzigen Brueder; Trier Germany
| | - V. Poeschel
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
| | - M. Pfreundschuh
- Hematology/Oncology; Saarland University Hospital; Homburg Germany
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7
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Murawski N, Pfreundschuh M, Zeynalova S, Poeschel V, Hänel M, Held G, Schmitz N, Viardot A, Schmidt C, Hallek M, Witzens-Harig M, Trümper L, Rixecker T, Zwick C. Optimization of rituximab for the treatment of DLBCL (I): dose-dense rituximab in the DENSE-R-CHOP-14 trial of the DSHNHL. Ann Oncol 2014; 25:1800-1806. [PMID: 24928834 DOI: 10.1093/annonc/mdu208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND To improve outcome of elderly patients with diffuse large B-cell lymphoma, dose-dense rituximab was evaluated in the prospective DENSE-R-CHOP-14 trial. PATIENTS AND METHODS Rituximab (375 mg/m(2)) was given on days 0, 1, 4, 8, 15, 22, 29, 43, 57, 71, 85, and 99 together with six CHOP-14 cycles. Results were to be compared with patients who had received the same chemotherapy in combination with eight 2-week applications of rituximab in RICOVER-60. RESULTS One hundred twenty-four patients are assessable. Dose-dense rituximab resulted in considerably higher serum levels during the first 50 days of treatment, but rituximab exposure time was not prolonged. Grade 3 and 4 infections were exceptionally high in the first 20 patients without anti-infective prophylaxis, but decreased after introduction of prophylaxis with aciclovir and cotrimoxazole in the remaining 104 patients (from 13% to 6% per cycle and from 35% to 18% per patient; P = 0.007 and P = 0.125, respectively). Patients with international prognostic index = 3-5 had higher complete response/complete response unconfirmed rates (82% versus 68%; P = 0.033) than in the respective RICOVER-60 population, but this did not translate into better long-term outcome, even though male hazard was decreased (event-free survival: from 1.5 to 1.1; progression-free survival: from 1.7 to 1.1; overall survival: from 1.4 to 1.0). CONCLUSIONS Dose-dense rituximab achieved higher rituximab serum levels, but was not more effective than eight 2-week applications in the historical control population, even though minor improvements in poor-prognosis and male patients cannot be excluded. The increased, though manageable toxicity, precludes its use in routine practice. Our results strongly support anti-infective prophylaxis with aciclovir and cotrimoxazole for all patients receiving R-CHOP.
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MESH Headings
- Acyclovir/therapeutic use
- Aged
- Aged, 80 and over
- Aging
- Anti-Infective Agents/therapeutic use
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/blood
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiviral Agents/therapeutic use
- Communicable Disease Control
- Communicable Diseases/drug therapy
- Cyclophosphamide/therapeutic use
- Disease-Free Survival
- Doxorubicin/therapeutic use
- Drug Administration Schedule
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Prednisone/therapeutic use
- Prospective Studies
- Rituximab
- Treatment Outcome
- Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
- Vincristine/therapeutic use
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Affiliation(s)
- N Murawski
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - M Pfreundschuh
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg.
| | | | - V Poeschel
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - M Hänel
- Internal Medicine III, Klinikum Chemnitz, Chemnitz
| | - G Held
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - N Schmitz
- Department of Haematology, Oncology and Stem Cell Transplantation, Asklepios Klinik St Georg, Hamburg
| | - A Viardot
- Innere Medizin, Universitätsklinikum Ulm, Ulm
| | | | - M Hallek
- Universitätsklinik Köln, Cologne
| | | | - L Trümper
- Universitätsklinikum Göttingen, Göttingen, Germany
| | - T Rixecker
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
| | - C Zwick
- Klinik für Innere Medizin I, Universitätsklinikum des Saarlandes, Homburg
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8
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Assmann G, Shihadeh K, Ong M, Ziepert M, Poeschel V, Pfreundschuh M. AB1263 Higher prevalence of anti-citrullinated protein antibodies (ACPA) without impact on prognosis in patients with aggressive B-non-hodgkin lymphoma (DLCBL):. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Pfreundschuh M, Ziepert M, Zeynalova S, Lengfelder E, Steinhauer H, Clemens MR, Nickenig C, Ho AD, Truemper LH, Hoffmann M, Mertelsmann RH, Metzner B, Mergenthaler H, Poeschel V, Schmitz N, Loeffler M. Six versus eight cycles of biweekly CHOP-14 with or without R in elderly patients (pts) with aggressive CD20 + B-cell lymphomas: Seven-year FU of the RICOVER-60 trial of the DSHNHL. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Poeschel V, Murawski N, Glass B, Zeynalova S, Fleckenstein J, Ziepert M, Kempf B, Loeffler M, Schmitz N, Pfreundschuh M. Aggressive craniofacial lymphoma in the pre-rituximab and rituximab era. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Pfreundschuh M, Poeschel V, Zeynalova S, Viardot A, Haenel M, Keller U, Reiser M, Murawski N, Loeffler M, Schubert J. Results of the SMARTE-R-CHOP-14 trial of the German high-grade non-Hodgkin lymphoma study group (DSHNHL). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Rube C, Ziepert M, Schmidberger H, Poeschel V, Müller R, Sautter-Bihl M, Fritz P, Loeffler M, Pfreundschuh M, Fleckenstein J. The Impact of Radiotherapy to Bulky Disease after R-CHOP Chemotherapy in Aggressive Lymphoma: Results from Two Prospective Trials of the German High-grade Non-Hodgkin-Lymphoma Study Group (DSHNHL) for Elderly Patients with DLBCL. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Pfreundschuh M, Zeynalova S, Poeschel V, Haenel M, Schmitz N, Ho AD, Reiser M, Loeffler M, Schubert J. Improved outcome of elderly patients with poor-prognosis diffuse large B-cell lymphoma (DLBCL) after dose-dense rituximab: Results of the DENSE-R-CHOP-14 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8508] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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