ACVBP versus CHOP plus Radiotherapy for Localized Aggressive Lymphoma

Abstract

In patients under 61 years of age, chemotherapy with three cycles of ACVBP followed by sequential consolidation is superior to three cycles of CHOP plus radiotherapy for the treatment of low-risk localized lymphoma.

Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): an open-label randomised phase 3 trial

“…During the second phase, patients receive a sequential consolidation treatment with drugs not used during induction. ACVBP improves results over CHOP in comparative trials assessing patients with localised diff use large B-cell lymphoma 8 and patients with more advanced disease. 9 The association of rituximab with ACVBP in patients younger than 60 years with an ageadjusted International Prognostic Index score of 1, as in our trial, seems to improve progression-free survival from 81% at 2 years 22 to 90%.…”

“…Two randomised studies done in the so-called prerituximab era showed that the intensifi ed doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone chemotherapy regimen (ACVBP) with subsequent sequential consolidation, compared with standard CHOP, can improve the outcome both in low-risk 8 and high-risk 9 groups of patients, according to the International Prognostic Index for aggressive lymphoma. 10 Similarly, the Deutsche Studiengruppe Hochmaligne Non-HodgkinLymphome 11 showed that the addition of etoposide to CHOP improves the event-free survival of patients younger than 60 years with aggressive lymph oma.…”

Czy należy stosować radioterapię w nieziarniczym rozlanym chłoniaku z dużych komórek B? Głos na tak

“…Niestety, spośród przeprowadzonych prospektywnych badań klinicznych z losowym doborem chorych przed "erą rytuksymabu" tylko jedno (ECOG 1484) zostało zaprojektowane optymalnie, co bardzo utrudnia interpretację wyników (tab. I) [16][17][18][19].…”

“…Badanie GELA 93-4 byłoby bliskie ideału, gdyby nie to, że randomizacją do obserwacji lub napromieniania niską dawką (30 Gy) objęto wyłącznie chorych z całkowitą remisją, a w przypadku częściowej remisji zawsze stosowano napromienianie dawką wyższą (40 Gy) [17,19]. W badaniu ECOG 1484 pomimo znamiennie większej liczby chorych z cechą "bulky" czas przeżycia wolnego od choroby (DFS) w ramieniu z leczeniem skojarzonym był istotnie lepszy.…”

Changing therapeutic landscape – The last decade

“…The role of radiotherapy seems to be diminishing. First, the French showed that even patients with stage 1 disease can be safely treated without irradiation and then the Germans showed that after the end of immunochemotherapy it is not necessary to irradiate areas of previously bulky disease that are in complete remission [20,21].…”