Interferon alfa 2b as maintenance therapy in poor risk diffuse large B-cell lymphoma in complete remission after intensive CHOP-BLEO regimens

Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon, but aggressive, type of B-cell lymphoma. Patients with relapsed refractory PMBCL (rrPMBCL) have limited therapeutic options and usually have a relatively poor outcome. Immune checkpoint blockade has become a potential treatment for this disease. We report here a case of a female patient with rrPMBCL who was treated with nivolumab plus gemcitabine, dexamethasone, and cisplatin (GDP) chemotherapy. Complete remission was achieved after four cycles of combined therapy. With continued nivolumab maintenance monotherapy, she has remained in complete remission for longer than 28 months. This is the first report of nivolumab plus GDP chemotherapy inducing complete remission in patient with rrPMBCL. This case supplements the limited literature and provides implications for clinical trial designs regarding the potential use of nivolumab in the treatment of rrPMBCL.

Download Full-text

Twenty Years of Autologous Stem Cell Transplantation in Diffuse Large B-Cell Lymphoma: A Single Portuguese Center Experience

Acta Médica Portuguesa ◽

10.20344/amp.6617 ◽

2016 ◽

Vol 29 (3) ◽

pp. 205

Author(s):

Margarida Dantas Brito ◽

Fernando Campilho ◽

Rosa Branca ◽

Carlos Vaz ◽

Susana Roncon ◽

...

Keyword(s):

Stem Cell ◽

Complete Remission ◽

Stem Cell Transplantation ◽

B Cell ◽

Autologous Stem Cell Transplantation ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell ◽

First Complete Remission

Introduction: Diffuse large B-cell lymphoma can be cured in 60% – 70% of patients. Autologous stem cell transplantation is the standard treatment for relapsed disease. This high-intensity treatment after first complete remission in patients with high International Prognostic Index remains controversial and was performed in our department during some years. Material and Methods: Retrospective study, review of clinical records. Results: This study evaluates the outcome of 113 patients transplanted between 1992 and 2012. Considering status before transplantation patients were divided in groups: a) first complete remission after 1 line of chemotherapy (n = 64); b) first complete remission after ≥ two chemotherapy lines (n = 15); c) second complete remission (n = 15); d) more advanced diseased (n = 19). Chemotherapy used in first line therapy was mainly R-CHOP (n = 71) and CHOP (n = 28). The median follow-up of patients still alive was 34 months (1 - 221). At five years, overall survival was 73% (± 5) and disease free survival was 75% (± 5). Conclusion: Conventional chemotherapy followed by autologous stem cell transplant is a safe and efficient option for selected patients. In our series 70% high-risk patients were free from disease with this strategy.

Download Full-text

6028 POSTER Late-onset neutropenia is infrequent and self-limiting in patients with diffuse large B-cell lymphoma in complete remission following therapy with rituximab in combination with chemotherapy

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(07)71319-8 ◽

2007 ◽

Vol 5 (4) ◽

pp. 353

Author(s):

R. Quek ◽

G. Lai ◽

M. Tao ◽

A. Chan ◽

F. Gao ◽

...

Keyword(s):

Complete Remission ◽

B Cell ◽

Cell Lymphoma ◽

Late Onset ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

Download Full-text

Fourth complete remission with immunosuppression withdrawal and irinotecan after both autologous and allogeneic transplants for diffuse large B cell lymphoma

Leukemia & Lymphoma ◽

10.1080/10428190903144642 ◽

2009 ◽

pp. 1-3

Author(s):

Neel Gupta ◽

Juliet Barker ◽

James Young ◽

Ariela Noy

Keyword(s):

Complete Remission ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

Download Full-text

Primary anaplastic large B-cell lymphoma in mandible: Long-term complete remission with R-CHOP regimen and involved field radiotherapy

Oral Oncology ◽

10.1016/j.oraloncology.2009.04.002 ◽

2009 ◽

Vol 45 (9) ◽

pp. e113

Author(s):

Pasquale Niscola ◽

Massimiliano Palombi ◽

Malgorzata Monika Trawinska ◽

Laura Scaramucci ◽

Marco Giovannini ◽

...

Keyword(s):

Complete Remission ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Chop Regimen ◽

Large B Cell Lymphoma ◽

Involved Field ◽

Involved Field Radiotherapy ◽

Large B Cell

Download Full-text

Rituximab compared to observation after high-dose consolidative first-line chemotherapy (HDC) with autologous stem cell transplantation in poor-risk diffuse large B-cell lymphoma: Updated results of the LNH98-B3 GELA study

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.8012 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 8012-8012 ◽

Cited By ~ 1

Author(s):

C. Haioun ◽

N. Mounier ◽

J. F. Emile ◽

S. Bologna ◽

B. Coiffier ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Induction Treatment ◽

High Dose ◽

Induction Phase ◽

Rituximab Maintenance ◽

Poor Risk ◽

Large B Cell Lymphoma ◽

Large B Cell

8012 Background: Rituximab has been evaluated as a single agent and also in combination with chemotherapy in aggressive and indolent lymphomas with evidence of efficacy. More recently, rituximab maintenance therapy has been successfully used to keep responding patients in remission. We have shown that consolidative HDC improves outcome of poor risk responder-patients (pts) with aggressive lymphoma. Methods: The aim of the present study was to evaluate the potential benefit, as randomly compared to observation, rituximab - 375 mg/m2/week for 4 weeks - 2 months after HDC, in decreasing the relapse rate (second randomization: R2). A secondary objective was to improve the response rate before HDC using the intensified ACE chemotherapy regimen (doxorubicin 75mg/m2 d1, cyclophosphamide 1g/m2 d1-d2, etoposide 150mg/m2 d1-d3) as compared to the standard ACVBP induction regimen (R1). Four cycles were delivered every 15 days. In responding pts, HDC (mitoxantrone 45 mg/m2, cyclophosphamide 1500 mg/m2 × 4d, etoposide 250 mg/m2 × 4d and carmustine 300 mg/m2) was started between d80 and d90. Results: From 10/99 to 05/03 (closing date), 476 pts younger than 60 years with diffuse large B-cell lymphoma and aa-IPI 2 or 3 (aa-IPI 3: 29%). were enrolled. 237 pts were assigned to ACE and 239 to ACVBP. Complete response (CR+CRu) rates to induction treatment did not significantly differ between the 2 regimens (65% and 63%, respectively). Death rate during induction phase was 4% in both arms. Among the 331 pts who received HDC, 269 were randomized (R2) to receive either rituximab (n=139) or observation (n=130). 545 infusions of rituximab were administered with no clinically relevant infectious toxicity except two severe VZV infections. With a median follow-up of 4 years after R2, a trend toward a better 4y-EFS was observed in the rituximab group (80% vs 71%, p=0.098). In addition, a two-sided log-rank test stratified by aa-IPI, induction treatment and response after HDC was performed and confirmed the results of the unstratified analysis. Conclusions: We conclude that early and brief rituximab maintenance is feasible after HDC and may prolong remission status. [Table: see text]

Download Full-text

REPOCH compared with RCHOP for the treatment of diffuse large B-cell lymphoma of activated B-cell type.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20081 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20081-e20081

Author(s):

Phillip Martinez-Knouse ◽

Edward Nabrinsky ◽

Anjana Chandran ◽

Timothy M. Lestingi ◽

Jacob D. Bitran

Keyword(s):

Complete Remission ◽

B Cell ◽

Retrospective Analysis ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Phase Iii ◽

Cell Type ◽

Large B Cell Lymphoma ◽

Grade 3 ◽

Large B Cell

e20081 Background: Patients with diffuse large B-cell lymphoma of activated B-cell type (DLBCL-ABC) have a worse prognosis than patients with DLBCL of germinal center origin. Recently, a phase III randomized trial of patients with DLBCL showed no improvement in response rates or progression free survival (PFS) with REPOCH compared to RCHOP. However, the PFS reported in this study was significantly better than expected, indicating that high-risk patients, such as those with DLBCL-ABC, may have been underrepresented. The optimal treatment for patients with DLBCL-ABC remains unknown. Methods: We undertook a retrospective analysis of patients with DLBCL treated in our practice from January 1, 2015 to May 31, 2019. We then examined treatment approaches and outcomes of patients treated for DLBCL-ABC. Results: We treated 136 patients with DLBCL and identified 18 of 136 patients with DLBCL-ABC. There were 9 men and 9 women with a median age of 74 years (range 26-92 years) and a median performance status of Eastern Cooperative Oncology Group 1, (0-2). The median international prognostic index score was 3. Nine of 18 patients were treated with REPOCH, 8 with RCHOP, and one with bendamustine and rituximab (BR). The stage distribution was stage I in 2 patients, stage III in 4 patients, and stage IV in 12 patients. Of 9 patients treated with REPOCH, 9 (100%) achieved a complete remission with no relapses to date. Of 8 patients treated with RCHOP, 6 (75%) achieved a complete remission and 2 had no response and died. The one patient treated with BR failed to respond and died. The median PFS for the 8 patients treated with RCHOP was 19.5 months; whereas, the PFS in the REPOCH group had not been reached at a median follow up of 2 years. Grade 3 and 4 toxicities were more common in the RCHOP group and included cardiomyopathy in 1 patient and two episodes of neutropenic fever (one resulting in septic shock and death). There were no grade 3 or 4 toxicities in the REPOCH group. Conclusions: In this retrospective analysis, our patients with DLBCL-ABC treated with REPOCH had better overall outcomes. A prospective trial in this subset of DLBCL patients is warranted.

Download Full-text

Prognostic Impact of Germinal Center–Associated Proteins and Chromosomal Breakpoints in Poor-Risk Diffuse Large B-Cell Lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.2006.05.5897 ◽

2006 ◽

Vol 24 (25) ◽

pp. 4135-4142 ◽

Cited By ~ 115

Author(s):

Gustaaf W. van Imhoff ◽

Evert-Jan G. Boerma ◽

Bronno van der Holt ◽

Ed Schuuring ◽

Leo F. Verdonck ◽

...

Keyword(s):

B Cell ◽

Expression Profile ◽

Germinal Center ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

High Dose ◽

Prognostic Impact ◽

Poor Risk ◽

Large B Cell Lymphoma ◽

Large B Cell

Purpose Outcome of diffuse large B-cell lymphoma (DLBCL) with a germinal center B-cell (GCB) expression profile is superior to that of non-GCB DLBCL. This conclusion is mainly derived from patients with mixed international prognostic index (IPI) risk profiles treated with CHOP-like therapy (cyclophosphamide, doxorubicin, vincristine, and prednisone). We wondered whether the prognostic impact of the expression profile would hold out in a homogeneous cohort of poor-risk DLBCL patients treated with high-dose sequential therapy (HDT) and autologous stem-cell transplantation (ASCT) as first-line therapy. Patients and Methods DLBCL from 66 newly diagnosed poor-risk patients, treated in two sequential prospective Dutch Hemato-Oncology Association (HOVON) trials, were studied retrospectively for expression of CD10, bcl6, MUM1/IRF4, bcl2, Ki67, and CD21+ follicular dendritic cells (FDC) by immunohistochemistry, and for the breakpoints of BCL2, BCL6, and MYC by fluorescent in situ hybridization (FISH). Lymphomas with any follicular component were excluded. Results A GCB immunophenotype profile was found in 58% and non-GCB immunophenotype profile in 42% of the tumors. Clinical characteristics of both groups were similar. Complete response (CR) rate was higher in patients with CD10+ tumors (58% v 30%; P = .03). A GCB immunophenotype profile, its constituting markers CD10 more than 30% and MUM1 less than 70%, and bcl2 less than 10% were each associated with a better overall survival (OS). FDC networks, equally present in GCB and non-GCB tumors, had superior CR (73% v 31%; P = .01), but disease-free survival rates were lower and there was no difference in OS rates. None of the breakpoints had a prognostic impact on outcome. Conclusion Also in patients with poor-risk DLBCL treated with HDT and ASCT, the GCB immunophenotype and bcl2 expression retained a major impact on survival.

Download Full-text