Rituximab maintenance for patients with aggressive B-cell lymphoma in first remission: results of the randomized NHL13 trial

Jaeger, Ulrich; Trněný, Marek; Melzer, Helen; Praxmarer, Michael; Nawarawong, Weerasak; Yehuda, Dina Ben; Goldstein, D.; Mihaljević, Biljana; İlhan, Osman; Ballova, Veronika; Hedenus, Michael; Hsiao, Liang Tsai; Au, Wing Y.; Burgstaller, Sonja; Weidinger, Gottfried; Keil, Felix; Dittrich, Ch.; Skrabs, Cathrin; Klingler, Antón; Chott, Andreas; Fridrik, Michael A.; Greil, Richard

doi:10.3324/haematol.2015.125344

Cited by 74 publications

(92 citation statements)

References 33 publications

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“…In NHL, discussions on R efficacy in women versus men were raised, as the final data of the NHL-13 study demonstrated a significantly better 3-year PFS for men versus women (89 vs. 78%, HR = 0.45) when treated with R maintenance after immunochemotherapy for aggressive lymphoma [35]. The fact that this is most likely related to a gender-depended higher R clearance rate in males resulting in underdosing had already been postulated [36,37], but the NHL-13 results seem to encourage further investigations along those lines.…”

Section: Discussionmentioning

confidence: 99%

Gender Aspects in Extranodal Marginal Zone B-Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue: Does Sex Matter?

Kiesewetter

Lukas²,

Dolak³

et al. 2016

Oncology

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Objectives: Gender-related aspects have been investigated in a variety of tumor entities including results on sex-specific differences in non-Hodgkin lymphoma. However, there are no data on gender differences in mucosa-associated lymphoid tissue (MALT) lymphoma. Methods: We have analyzed 327 patients treated between 1999 and 2015 with a median follow-up time of 55.2 months. Results: There was a female predominance, with 197 female (60.2%) and 130 male patients (39.8%, female-to-male ratio 1.5). The mean age was comparable between female and male patients (61.2 vs. 61.7 years, p = 0.777). Female patients less frequently had gastric MALT lymphoma (31.5 vs. 39.2%), but this was not statistically significant (p = 0.149). Extragastric manifestations were equally distributed, except for parotid (p = 0.003) and breast lymphoma (n = 8, 100% female) showing a female predominance. This was most likely related to a higher rate of active autoimmune disorders in women (35.6 vs. 11.0%, p < 0.001). β₂-Microglobulin elevation at diagnosis occurred more often in female patients (42.8 vs. 26.0%; p = 0.008). However, this did not translate into a worse progression-free survival for female (56.0 months, 95% CI 30.1-81.9) versus male patients (49.0 months, 95% CI 25.4-72.5, p = 0.433). Overall survival did not differ between groups. Conclusion: Our data show surprisingly little differences between female and male patients with MALT lymphoma. Both sexes appeared to have well-balanced clinical features and an identical prognosis.

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Section: Discussionmentioning

confidence: 99%

Gender Aspects in Extranodal Marginal Zone B-Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue: Does Sex Matter?

Kiesewetter

Lukas²,

Dolak³

et al. 2016

Oncology

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“…The differences in PFS or OS were not significant, but there was a trend in favor of maintenance therapy. 32 90 Y-ibritumomab tiuxetan has been used as consolidation alone after R-CHOP or in combination with carmustine, etoposide, cytarabine, and melphalan (Z-BEAM) before autologous transplant. One randomized study has been published that compares carmustine, etoposide, cytarabine, and melphalan (BEAM) and Z-BEAM and reports a possible benefit in favor of Z-BEAM.…”

Section: Patients Not Eligible For Transplantmentioning

confidence: 99%

Diffuse large B-cell lymphoma: R-CHOP failure—what to do?

2016

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Although rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard treatment for patients with diffuse large B-cell lymphoma (DLBCL),~30% to 50% of patients are not cured by this treatment, depending on disease stage or prognostic index. Among patients for whom R-CHOP therapy fails, 20% suffer from primary refractory disease (progress during or right after treatment) whereas 30% relapse after achieving complete remission (CR). Currently, there is no good definition enabling us to identify these 2 groups upon diagnosis. Most of the refractory patients exhibit double-hit lymphoma (MYC-BCL2 rearrangement) or double-protein-expression lymphoma (MYC-BCL2 hyperexpression) which have a more aggressive clinical picture. New strategies are currently being explored to obtain better CR rates and fewer relapses. Although young relapsing patients are treated with high-dose therapy followed by autologous transplant, there is an unmet need for better salvage regimens in this setting. To prevent relapse, maintenance therapy with immunomodulatory agents such as lenalidomide is currently undergoing investigation. New drugs will most likely be introduced over the next few years and will probably be different for relapsing and refractory patients. Learning Objectives• To be able to determine at diagnosis which DLBCL patients will likely experience treatment failure with R-CHOP • To understand the mechanisms that underlie resistance to standard treatments • To be able to assess the new proposed drugs, along with their efficacy for specific lymphoma populations such as those with double-hit lymphoma or double-protein-expression lymphoma • To learn more about potential solutions for refractory or relapsing patients

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“…In der RICOVER-Studie waren 6-mal R-CHOP-14 + 8 Gaben Rituximab der beste Arm [44], eine Erhaltungstherapie über 2 Jahre bringt jedoch keinen Vorteil [31].…”

Section: Introductionunclassified