Journal ArticleDOI
Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial
Richard Delarue,Hervé Tilly,Nicolas Mounier,Tony Petrella,Gilles Salles,Catherine Thieblemont,Catherine Thieblemont,Serge Bologna,Hervé Ghesquières,Maya Hacini,Christophe Fruchart,Loic Ysebaert,Christophe Fermé,Olivier Casasnovas,Achiel Van Hoof,Antoine Thyss,Alain Delmer,Olivier Fitoussi,Thierry Jo Molina,Thierry Jo Molina,Corinne Haioun,André Bosly +21 more
TLDR
In elderly patients with untreated diffuse large B-cell lymphoma and at least one adverse prognostic factor, a 2-week dose-dense R-CHOP regimen did not improve efficacy compared with the 3-week standard schedule and was associated with increased need for red-blood-cell transfusion.Abstract:
Summary Background Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has become the standard of care for elderly patients with diffuse large B-cell lymphoma. We aimed to ascertain if a dose-dense R-CHOP regimen administered every 2 weeks (R-CHOP14) was superior to the standard 3-week schedule (R-CHOP21). Methods We did a randomised phase 3 trial at 83 centres in four countries. 602 patients aged 60–80 years with untreated diffuse large B-cell lymphoma and at least one adverse prognostic factor (age-adjusted international prognostic index ≥1) were eligible for the study. We randomly allocated individuals to R-CHOP—ie, rituximab (375 mg/m 2 ), cyclophosphamide (750 mg/m 2 ), doxorubicin (50 mg/m 2 ), vincristine (1·4 mg/m 2 , up to 2 mg) all on day 1, and prednisone 40 mg/m 2 daily for 5 days—administered every 14 days (n=304) or every 21 days (n=298) for eight cycles. We did permuted-block randomisation (block size four, allocation ratio 1:1) stratified by centre and number of adverse prognostic factors. The primary endpoint was event-free survival. Our analysis was of the intention-to-treat population, and we present the final analysis. This study is registered with ClinicalTrials.gov, number NCT00144755. Findings Two patients allocated R-CHOP21 were ineligible for the study and were excluded from analyses. After median follow-up of 56 months (IQR 27–60), 3-year event-free survival was 56% (95% CI 50–62) in the R-CHOP14 group and 60% (55–66) in the R-CHOP21 group (hazard ratio 1·04, 95% CI 0·82–1·31; p=0·7614). Grade 3–4 neutropenia occurred in 224 (74%) of 304 patients allocated R-CHOP14 and 189 (64%) of 296 assigned R-CHOP21, despite increased use of granulocyte colony-stimulating factor in the R-CHOP14 group compared with the R-CHOP21 group. 143 (47%) patients in the R-CHOP14 group received at least one red-blood-cell transfusion versus 93 (31%) in the R-CHOP21 group (p=0·0001). 35 (12%) patients allocated R-CHOP14 received at least one platelet transfusion versus 25 (8%) assigned R-CHOP21 (p=0·2156). 155 (51%) patients who were assigned R-CHOP14 had at least one serious adverse event compared with 140 (47%) who were allocated R-CHOP21. Interpretation In elderly patients with untreated diffuse large B-cell lymphoma and at least one adverse prognostic factor, a 2-week dose-dense R-CHOP regimen did not improve efficacy compared with the 3-week standard schedule. The frequency of toxic side-effects was similar between regimens, but R-CHOP14 was associated with increased need for red-blood-cell transfusion. Funding Groupe d'Etude des Lymphomes de l'Adulte (GELA), Amgen.read more
Citations
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Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update
Thomas J. Smith,Kari Bohlke,Gary H. Lyman,Kenneth R. Carson,Jeffrey Crawford,Scott J. Cross,John M. Goldberg,James Khatcheressian,Natasha B. Leighl,Cheryl L. Perkins,George Somlo,James L. Wade,Antoinette J. Wozniak,James O. Armitage +13 more
TL;DR: Current recommendations for the management of patients exposed to lethal doses of total-body radiotherapy, but not doses high enough to lead to certain death as a result of injury to other organs, include the prompt administration of CSFs.
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Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Hervé Tilly,M. Gomes da Silva,Umberto Vitolo,Andrew Jack,Michel Meignan,Armando López-Guillermo,Jan Walewski,Marc André,Peter Johnson,Michael Pfreundschuh,Marco Ladetto +10 more
TL;DR: This work presents the results of a double-blind, placebo-controlled study conducted at the University of Southampton over a two-week period in June and July of last year that demonstrated clear trends in prognosis for breast cancer in smokers and women with a history of smoking.
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Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity.
Laurie H. Sehn,Randy D. Gascoyne +1 more
TL;DR: It will be necessary to prioritize drugs that affect key driver pathways and to combine them rationally to optimize their benefit and improve prognostication and the availability of predictive biomarkers will be crucial to allow for the possibility of individualized risk-adapted therapy.
Journal ArticleDOI
Event-Free Survival at 24 Months Is a Robust End Point for Disease-Related Outcome in Diffuse Large B-Cell Lymphoma Treated With Immunochemotherapy
Matthew J. Maurer,Hervé Ghesquières,Hervé Ghesquières,Jean-Philippe Jais,Thomas E. Witzig,Corinne Haioun,Carrie A. Thompson,Richard Delarue,Ivana N. Micallef,Frederic Peyrade,William R. Macon,Thierry Jo Molina,Nicolas Ketterer,Sergei Syrbu,Olivier Fitoussi,Paul J. Kurtin,Cristine Allmer,Emmanuelle Nicolas-Virelizier,Susan L. Slager,Thomas M. Habermann,Brian K. Link,Gilles Salles,Hervé Tilly,James R. Cerhan +23 more
TL;DR: Patients withDLBCL who achieve EFS24 have a subsequent overall survival equivalent to that of the age- and sex-matched general population, and should be considered as an end point for future studies of newly diagnosed DLBCL.
Journal ArticleDOI
Diffuse large B-cell lymphoma: 2019 update on diagnosis, risk stratification, and treatment
Yang Liu,Stefan K. Barta +1 more
TL;DR: Diffuse large B‐cell lymphoma is the most common type of aggressive non‐Hodgkin lymphoma originating from the germinal center, and it represents a heterogeneous group of diseases with variable outcomes that are differentially characterized by clinical features, cell of origin (COO), molecular features, and most recently, frequently recurring mutations.
References
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WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues
TL;DR: Thank you very much for reading who classification of tumours of haematopoietic and lymphoid tissues, and maybe you have knowledge that, people have look hundreds of times for their chosen readings like this, but end up in malicious downloads.
Journal ArticleDOI
CHOP Chemotherapy plus Rituximab Compared with CHOP Alone in Elderly Patients with Diffuse Large-B-Cell Lymphoma
Bertrand Coiffier,Eric Lepage,Josette Brière,Raoul Herbrecht,Hervé Tilly,Reda Bouabdallah,Pierre Morel,Eric Van Den Neste,Gilles Salles,Philippe Gaulard,Felix Reyes,Pierre Lederlin,Christian Gisselbrecht +12 more
TL;DR: A randomized trial to compare CHOP chemotherapy plus rituximab with CHOP alone in elderly patients with diffuse large-B-cell lymphoma found the rate of complete response was significantly higher in the group that received CHOP plus r ituximabs than in thegroup that receivedCHOP alone.
Journal ArticleDOI
Report of an International Workshop to Standardize Response Criteria for Non-Hodgkin's Lymphomas
Bruce D. Cheson,Sandra J. Horning,B Coiffier,Margaret A. Shipp,Richard I. Fisher,J Connors,T A Lister,Julie M. Vose,Antonio J. Grillo-Lopez,A Hagenbeek,F Cabanillas,D Klippensten,W Hiddemann,R A Castellino,Nancy L. Harris,James O. Armitage,W. D. Carter,Richard T. Hoppe,George P. Canellos +18 more
TL;DR: Standardized guidelines for response assessment are needed to ensure comparability among clinical trials in non-Hodgkin's lymphomas (NHL), and two meetings were convened among United States and international lymphoma experts to develop a uniform set of criteria for assessing response in clinical trials.
Journal ArticleDOI
Comparison of a Standard Regimen (CHOP) with Three Intensive Chemotherapy Regimens for Advanced Non-Hodgkin's Lymphoma
Richard I. Fisher,Ellen R. Gaynor,Steve Dahlberg,Martin M. Oken,Thomas M. Grogan,Evonne M. Mize,John H. Glick,Charles A. Coltman,Thomas P. Miller +8 more
TL;DR: CHOP remains the best available treatment for patients with advanced-stage intermediate-grade or high-grade non-Hodgkin's lymphoma.
Journal ArticleDOI
2006 Update of Recommendations for the Use of White Blood Cell Growth Factors: An Evidence-Based Clinical Practice Guideline
Thomas J. Smith,James Khatcheressian,Gary H. Lyman,Howard Ozer,James O. Armitage,Lodovico Balducci,Charles L. Bennett,Scott B. Cantor,Jeffrey Crawford,Scott J. Cross,George D. Demetri,Christopher E. Desch,Philip A. Pizzo,Charles A. Schiffer,Lee S. Schwartzberg,Mark R. Somerfield,George Somlo,James C. Wade,James L. Wade,Rodger J. Winn,Antoinette J. Wozniak,Antonio C. Wolff +21 more
TL;DR: Reduction in febrile neutropenia (FN) is an important clinical outcome that justifies the use of CSFs, regardless of impact on other factors, when the risk of FN is approximately 20% and no other equally effective regimen that does not require CSFs is available.
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