A retrospective study on prephase therapy prior to definitive multiagent chemotherapy in aggressive lymphomas

Abstract

Diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL) are aggressive non-Hodgkin's lymphomas (NHLs) that evolve rapidly and are fatal if untreated [1]. While the majority of patients are successfully initiated on multiagent chemotherapy, there is a subgroup of patients, particularly elderly patients and those with high disease burden, who are at risk for developing treatmentrelated toxicities during the initial phase of therapy [2]. Prephase therapy, a regimen consisting of corticosteroids with or without low-dose chemotherapy, has been used as a preventive strategy prior to definitive multiagent chemotherapy to ameliorate the development of toxicity, such as febrile neutropenia, tumor lysis syndrome (TLS), deterioration in performance status (PS), and death; however, data regarding the efficacy of this approach is limited [2-4]. We present data from our experience at the University of North Carolina Cancer Hospital, NC, U.S.A. on the safety and efficacy of prephase therapy prior to definitive multiagent chemotherapy in patients with aggressive NHLs. We conducted a retrospective analysis of patients 18 years and older with newly diagnosed DLBCL or BL between January 2014 and December 2017. Patients were identified via the Carolina Data Warehouse for Health database per Institutional Review Board-approved protocol. Patients with primary central nervous system lymphoma, or previously diagnosed with an indolent or low-grade lymphoma that transformed to an aggressive NHL were CONTACT Christopher Dittus,

Prognostic Impact of Prephase Treatment Prior to First-Line Treatment in DLBCL: A Population-Based Registry Study

“…Rasburicase for high tumour load is systematically used in our center and can explain the absence of lysis syndrome. Recently, a retrospective study on PP prior to defnitive multiagent chemotherapy in aggressive lymphomas did not report any signifcant diference in the episodes of febrile neutropenia, tumour lysis syndrome, hospitalization, emergency visits, or 30-day mortality [10]. In our study, PP was primarily a tritherapy (72%) and most often combined with corticosteroids, a vinca alkaloid (vincristine or vindesine), and cyclophosphamide.…”

“…However, data in the real-world clinical practice are limited [10,11], and no study to our knowledge has evaluated the patient-level response of prephase treatment on overall survival (OS). Given the negative prognostic impact of decreasing the immunochemotherapy (ICT) intensity dose [12][13][14][15], it seemed important to evaluate the prognostic impact of PP and thereby justify consideration of prephase treatment prior to frst-line treatment in DLBCL.…”

HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis

“…Use of prephase chemotherapy has shown to improve performance status, and decrease first-cycle toxicity and TRM in aggressive lymphoma. 30,31 Treatment delays and dose reduction may have occurred due to chemotherapy-related toxicity concerns by the treating physician. However, our data demonstrate that even intensive chemotherapy regimens are feasible in people with HIV receiving appropriate supportive care.…”

Effectiveness of Fractionated Rituximab in Preventing Tumor Lysis Syndrome in Aggressive B-Cell Lymphoma: Insights from Real-Life Clinical Practice

“…A \soutprophase pre-phase regimen administered before the initial cycle of immuno-chemotherapy, commonly utilizing steroids alone or in combination with vincristine or cyclophosphamide, is widely employed in acute lymphoblastic leukemia and high-risk B-cell lymphoma [7, 24][31-34]. This strategy has demonstrated efficacy in reducing TLS and therapy-related mortality [27, 28,[31][32][33][34][35][36]. In our cohort, the majority of patients (82%) received a steroid pre-phase, which may have contributed to the observed low incidence of TLS following subsequent administration of fractionated rituximab.…”