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Malignant Lymphomas |
1 Complejo Hospitalario de Zamora
2 Hospital Marqués de Valdecilla, Santander
3 Hospital Duran i Reynals, L’Hospitalet de Llobregat
4 Hospital La Paz, Madrid
5 Hospital Juan Canalejo, La Coruña
6 Hospital Germans Trias i Pujol, Badalona
7 Hospital Dr. Peset, Valencia
8 Hospital del Mar, Barcelona
9 Hospital Clínico de Madrid
10 Hospital Universitario de Salamanca
11 Hospital Universitario de Getafe
12 Hospital Severo Ochoa, Leganés
13 Hospital General de Castellón
14 Hospital Virgen del Puerto, Plasencia
15 Hospital General de Jerez, Jerez de la Frontera
16 Hospital Carlos Haya, Málaga
17 Hospital Doce de Octubre, Madrid, Spain
Correspondence: Alejandro Martín, MD, PhD, Department of Hematology, Complejo Hospitalario de Zamora, Avenida de Requejo 35, Zamora 49022, Spain. E-mail:amartingar{at}aehh.org
Background: The role of re-treatment with rituximab in aggressive B-cell lymphomas still needs to be defined. This study evaluated the influence of prior exposure to rituximab on response rates and survival in patients with diffuse large B-cell lymphoma treated with rituximab plus etoposide, cytarabine, cisplatinum and methylprednisolone (R-ESHAP).
Design and Methods: We retrospectively analyzed 163 patients with relapsed or refractory diffuse large B-cell lymphoma who received R-ESHAP as salvage therapy with a curative purpose. Patients were divided into two groups according to whether rituximab had been administered (n=94, "R+" group) or not (n=69, "R-" group) prior to R-ESHAP.
Results: Response rates were significantly higher in the R- group in the univariate but not in the multivariate analysis. In the analysis restricted to the R+ group, we observed very low complete remission and overall response rates in patients with primary refractory disease (8% and 33%, respectively), as compared to those in patients who were in first partial remission (41% and 86%) or who had relapsed disease (50% and 75%) (p<0.01 in both cases). Overall, 60% and 65% of patients in the R+ and R- groups, respectively, underwent stem-cell transplantation after the salvage therapy. With a median follow-up of 29 months (range, 6–84), patients in the R+ group had significantly worse progression-free survival (17% vs. 57% at 3 years, p<0.0001) and overall survival (38% v 67% at 3 years, p=0.0005) than patients in the R- group. Prior exposure to rituximab was also an independent adverse prognostic factor for both progression-free survival (RR: 2.0; 95% CI: 1.2–3.3, p=0.008) and overall survival (RR: 2.2; 95% CI: 1.3–3.9, p=0.004).
Conclusions: R-ESHAP was associated with a high response rate in patients who were not refractory to upfront rituximab-based chemotherapy. However, the survival outcome was poor for patients previously exposed to rituximab, as compared to in those who had not previously been treated with rituximab.
Key words: R-ESHAP, salvage therapy, diffuse large B-cell lymphoma, rituximab.
This article has been cited by other articles:
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  A. Martin, M.-D. Caballero, and on behalf of the Grupo Espanol de Linfomas/Traspla R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: influence of prior autologous stem-cell transplantation on outcome Haematologica, May 1, 2009; 94(5): 744 - 744. [Full Text] [PDF]
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