Short-course R-CHOP followed by 90Y-Ibritumomab tiuxetan in previously untreated high-risk elderly diffuse large B-cell lymphoma patients: 7-year long-term results

Abstract

An update at 7 years was conceived for our multicenter phase II study in which 55 elderly high-risk untreated diffuse large B-cell lymphoma patients were treated with 90Y-ibritumomab tiuxetan after a short course of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) as long-term follow-up analyses of this combined therapeutic modality are lacking. The overall response rate to the entire regimen was 80%, including 73% (40/55) of complete response (CR) rate and 7% (4/55) of partial response rate. At the time of writing, 24/55 (43.6%) patients experienced a progression disease and 20 of 40 (50%) patients who obtained a CR are still alive in continuous CR. With a median follow-up of 7 years, the disease-free survival was 43.3% and the progression-free survival was 36.1%. The overall survival at 7.9 years was 38.9% (27 deaths mainly because of lymphoma). Two patients developed secondary hematological malignancies, an acute myeloid leukemia and a myelodysplastic syndrome, at 4 and 3 years from radioimmunotherapy, respectively. Our data confirm the feasibility, efficacy and safety of four cycles of R-CHOP followed by radioimmunotherapy consolidation even in the long term: this combination allows dispensing less chemotherapy in a frail group of patients without invalidating response quality and duration.

Rituximab‐PECC induction followed by 90Y‐ibritumomab tiuxetan consolidation in relapsed or refractory DLBCL patients who are ineligible for or have failed ASCT: results from a phase II HOVON study

“…Five of our patients (8%) developed a secondary malignancy. As the overall incidence of treatment-related myelodysplastic syndrome/acute myeloid leukaemia and solid tumours has been reported to range from 0 to 12% with conventional dose chemotherapy or radiotherapy, the 8% observed in our trial is within this range (Stefoni et al, 2016). The 4 cycles of R-PECC also showed a promising efficacy in this unfavourable population of relapsed DLBCL patients, with an ORR of 63% and 27% CR.…”

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

“…Lenalidomide has also been added to R-CHOP, as well as used as maintenance therapy in responding patients, with promising results [29,64,65]. Other agents added to induction R-CHOP or utilized as maintenance/consolidation therapy across all age groups have included everolimus, enzastaurin, and radioimmunotherapy [24,[66][67][68][69][70]. In our study of older patients, initial non-R-CHOP regimens were utilized in 38.2% of patients.…”

Challenges and Opportunities in the Management of Diffuse Large B-Cell Lymphoma in Older Patients

“…[107] However, this approach has not moved forward to a randomized setting and is rarely applied due to concerns about secondary leukemia, even though the incidence of treatmentrelated myeloid neoplasms in this setting is low (about 4% over 10 years). [108,109] Maintenance lenalidomide is one approach that was examined in a randomized study. The phase 3 REMARC trial demonstrated improved PFS for patients age 60-80 who achieved complete or partial response to RCHOP and received 2 years of maintenance lenalidomide (HR:0.77, 95% CI, 0.54-0.93).…”

“…Ibritumomab tiuxetan was examined as consolidation after four cycles of R‐CHOP in a single‐arm study for patients older than 60, with 85% PFS at 2 years [107]. However, this approach has not moved forward to a randomized setting and is rarely applied because concerns about secondary leukemia, even though the incidence of treatment‐related myeloid neoplasms in this setting is low (about 4% over 10 years) [108, 109].…”