R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study
Copyright policy )R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study
The role of re-treatment with rituximab in aggressive B-cell lymphomas still needs to be defined. This study evaluated the influence of prior exposure to rituximab on response rates and survival in patients with diffuse large B-cell lymphoma treated with rituximab plus etoposide, cytarabine, cisplatinum and methylprednisolone (R-ESHAP).We retrospectively analyzed 163 patients with relapsed or refractory diffuse large B-cell lymphoma who received R-ESHAP as salvage therapy with a curative purpose. Patients were divided into two groups according to whether rituximab had been administered (n=94, "R+" group) or not (n=69, "R-" group) prior to R-ESHAP.Response rates were significantly higher in the R- group in the univariate but not in the multivariate analysis. In the analysis restricted to the R+ group, we observed very low complete remission and overall response rates in patients with primary refractory disease (8% and 33%, respectively), as compared to those in patients who were in first partial remission (41% and 86%) or who had relapsed disease (50% and 75%) (p<0.01 in both cases). Overall, 60% and 65% of patients in the R+ and R- groups, respectively, underwent stem-cell transplantation after the salvage therapy. With a median follow-up of 29 months (range, 6-84), patients in the R+ group had significantly worse progression-free survival (17% vs. 57% at 3 years, p<0.0001) and overall survival (38% v 67% at 3 years, p=0.0005) than patients in the R- group. Prior exposure to rituximab was also an independent adverse prognostic factor for both progression-free survival (RR: 2.0; 95% CI: 1.2-3.3, p=0.008) and overall survival (RR: 2.2; 95% CI: 1.3-3.9, p=0.004).R-ESHAP was associated with a high response rate in patients who were not refractory to upfront rituximab-based chemotherapy. However, the survival outcome was poor for patients previously exposed to rituximab, as compared to in those who had not previously been treated with rituximab.
Adult, Adolescent, diffuse large B-cell lymphoma, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Retrospective Studies, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged, Dexamethasone, Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans, Antibodies, Monoclonal, Murine-Derived, Young Adult, rituximab, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult, Antineoplastic Combined Chemotherapy Protocols, Humans, Diseases of the blood and blood-forming organs, salvage therapy, Medical Subject Headings::Named Groups::Persons::Age Groups::Adolescent, Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Pyrimidines::Pyrimidine Nucleosides::Cytidine::Cytarabine, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged, Aged, Etoposide, Retrospective Studies, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome, Salvage Therapy, Medical Subject Headings::Diseases::Immune System Diseases::Immunoproliferative Disorders::Lymphoproliferative Disorders::Lymphoma::Lymphoma, Non-Hodgkin::Lymphoma, B-Cell::Lymphoma, Large B-Cell, Diffuse, Medical Subject Headings::Chemicals and Drugs::Carbohydrates::Glycosides::Glucosides::Etoposide, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Antibodies, Monoclonal::Antibodies, Monoclonal, Murine-Derived, Cytarabine, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Young Adult, Antibodies, Monoclonal, Medical Subject Headings::Chemicals and Drugs::Inorganic Chemicals::Chlorine Compounds::Cisplatin, R-ESHAP, Middle Aged, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Clinical Protocols::Antineoplastic Protocols::Antineoplastic Combined Chemotherapy Protocols, Treatment Outcome, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Antibodies, Monoclonal, Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids::Steroids, Fluorinated::Dexamethasone, Lymphoma, Large B-Cell, Diffuse, RC633-647.5, Cisplatin, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Combined Modality Therapy::Salvage Therapy, Rituximab
Adult, Adolescent, diffuse large B-cell lymphoma, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Retrospective Studies, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged, Dexamethasone, Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans, Antibodies, Monoclonal, Murine-Derived, Young Adult, rituximab, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult, Antineoplastic Combined Chemotherapy Protocols, Humans, Diseases of the blood and blood-forming organs, salvage therapy, Medical Subject Headings::Named Groups::Persons::Age Groups::Adolescent, Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Pyrimidines::Pyrimidine Nucleosides::Cytidine::Cytarabine, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle Aged, Aged, Etoposide, Retrospective Studies, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome, Salvage Therapy, Medical Subject Headings::Diseases::Immune System Diseases::Immunoproliferative Disorders::Lymphoproliferative Disorders::Lymphoma::Lymphoma, Non-Hodgkin::Lymphoma, B-Cell::Lymphoma, Large B-Cell, Diffuse, Medical Subject Headings::Chemicals and Drugs::Carbohydrates::Glycosides::Glucosides::Etoposide, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Antibodies, Monoclonal::Antibodies, Monoclonal, Murine-Derived, Cytarabine, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Young Adult, Antibodies, Monoclonal, Medical Subject Headings::Chemicals and Drugs::Inorganic Chemicals::Chlorine Compounds::Cisplatin, R-ESHAP, Middle Aged, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Clinical Protocols::Antineoplastic Protocols::Antineoplastic Combined Chemotherapy Protocols, Treatment Outcome, Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Antibodies, Monoclonal, Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Steroids::Steroids, Fluorinated::Dexamethasone, Lymphoma, Large B-Cell, Diffuse, RC633-647.5, Cisplatin, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Combined Modality Therapy::Salvage Therapy, Rituximab
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