Additional Survival Benefit of Involved-Lesion Radiation Therapy After R-CHOP Chemotherapy in Limited Stage Diffuse Large B-Cell Lymphoma

Abstract Abstract 3751 Poster Board III-687 Limited-stage non-Hodgkin's lymphomas with bulky mass are known to have a poor prognosis as like to those with advanced disease. There are very limited data to compare the results of chemotherapy alone with those of combined modality treatment. However, defining local failure at bulky sites as one component of relapse, radioimmuotherapy (RIT) appears to reduce failure rates at sites of bulky disease. We assessed the clinical efficacy and toxicity of 6th R-CHOP chemotherapy and followed by ibritumomab tuixetan (Zevalin¢ç) consolidation in patients with bulky diffuse large B cell lymphoma (DLBCL). Patients and Methods This prospective, multi-center phase II clinical trial included the patients following as: i) patients with newly diagnosed CD20+ DLBCL ii) patients with stage I/II and bulky disease defined by maximum diameter greater than 10 cm or any mediastinal mass exceeding 1/3 the maximum trans-thoracic diameter (more than 8 cm) iii) patients that achieved a complete (CR) or partial response (PR) after 6th R-CHOP chemotherapy iv) aged over 18 years and ECOG performance status 0-2. Conventional, single dose of ibritumomab tuixetan (0.4 mCi/kg) was administered after 6th R-CHOP. Clinical response was evaluated after completion of 3rd and 6th R-CHOP and at 8 and 20 weeks after RIT, and assessed according to revised International Workshop Criteria. Results Twenty patients were treated with ibritumomab tuixetan as consolidation. Median age was 45.5 years and median size of bulky mass was 10.0 × 6.6 at diagnosis. 5 patients (35%) presented with high-intermediate or high risk by IPI and 4 patients underwent debulking operation. After a median of 17.5 months follow-up, the overall response rate was 95%, with a 80% CR and 15% PR. Two patients with PR after R-CHOP chemotherapy improved to CR after consolidation. However, four patients (20%) experienced a relapse with one of them progressed within 1 month after RIT. 2-year probability of progression-free survival (PFS) was 78.9 ±9.1%. The adverse events were mainly hematologic toxicities (more than grade3); neutropenia (60%) and thrombocytopenia (35%). Only one patient experienced a febrile neutropenia. Conclusions Consolidation treatment with Ibritumomab tuixetan resulted in a favorable response with tolerable toxicity in patients with bulky DLBCL. Disclosures: No relevant conflicts of interest to declare.

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Limited-Stage Diffuse Large B-cell Lymphoma in Head and Neck Treated With CHOP or Rituximab-CHOP (R-CHOP) Plus Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.1651 ◽

2012 ◽

Vol 84 (3) ◽

pp. S618

Author(s):

S. Ohga ◽

K. Nakamura ◽

Y. Shioyama ◽

T. Sasaki ◽

T. Nonoshita ◽

...

Keyword(s):

Radiation Therapy ◽

B Cell ◽

Head And Neck ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Limited Stage ◽

Large B Cell Lymphoma ◽

Large B Cell

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Benefit of Consolidative Radiation Therapy in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP Chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.3441 ◽

2010 ◽

Vol 28 (27) ◽

pp. 4170-4176 ◽

Cited By ~ 150

Author(s):

Jack Phan ◽

Ali Mazloom ◽

L. Jeffrey Medeiros ◽

Tony G. Zreik ◽

Christine Wogan ◽

...

Keyword(s):

Radiation Therapy ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Stage I ◽

Disease Stage ◽

Chop Chemotherapy ◽

Bulky Disease ◽

Large B Cell Lymphoma ◽

Large B Cell

Purpose The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The role of consolidative radiation therapy (RT) in the setting of R-CHOP chemotherapy is not well reported. This retrospective analysis is an attempt to clarify this role. Patients and Methods Subjects were 469 patients with histologically confirmed DLBCL treated between January 2001 and December 2007. Variables including age, sex, Ann Arbor disease stage, bulky disease status, standardized uptake values (SUVs) on positron emission tomography (PET), International Prognostic Index (IPI), and Ki67 staining (proliferation). Results Of 469 patients, 190 (40.5%) had stage I or II disease and 279 (59.5%) had stage III or IV disease, 327 (70%) had at least six cycles of R-CHOP, and 142 (30.2%) had involved-field RT (dose, 30 to 39.6 Gy) after complete response to chemotherapy. Median follow-up was 36 months (range, 8 to 85 months). Multivariate analysis showed that RT (P < .0001), IPI score (P = .001), response to therapy (P = .001), use of six to eight cycles of R-CHOP (P < .001), and combined presence (P = .006) or absence (P = .025) of high Ki67, high PET SUV, and bulky disease influenced overall survival (OS) and progression-free survival (PFS). Matched-pair analyses of patients who received six to eight cycles of R-CHOP with stage I or II disease (44 pairs) and all stages (74 pairs) indicated that RT improved OS (hazard ratio [HR], 0.52 and 0.29, respectively) and PFS (HR, 0.45 and 0.24, respectively) compared with no RT. Conclusion This study showed significant improvements in OS and PFS among patients who received consolidation RT after R-CHOP chemotherapy for DLBCL.

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