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Impact of pre-transplant rituximab on survival after autologous hematopoietic stem cell transplantation for diffuse large B cell lymphoma. Biol Blood Marrow Transplant 2009 Nov;15(11):1455-64 PMID: 19822306 PMCID: PMC2913553

Pubmed ID

19822306

Abstract

Incorporation of the anti-CD20 monoclonal antibody rituximab into front-line regimens to treat diffuse large B cell lymphoma (DLBCL) has resulted in improved survival. Despite this progress, however, many patients develop refractory or recurrent DLBCL and then undergo autologous hematopoietic stem cell transplantation (AuHCT). It is unclear to what extent pre-transplant exposure to rituximab affects outcomes after AuHCT. Outcomes of 994 patients receiving AuHCT for DLBCL between 1996 and 2003 were analyzed according to whether rituximab was (n = 176; +R cohort) or was not (n = 818; -R cohort) administered with front-line or salvage therapy before AuHCT. The +R cohort had superior progression-free survival (PFS; 50% vs 38%; P = .008) and overall survival (OS; 57% vs 45%; P = .006) at 3 years. Platelet and neutrophil engraftment were not affected by exposure to rituximab. Nonrelapse mortality (NRM) did not differ significantly between the 2 cohorts. In multivariate analysis, the +R cohort had improved PFS (relative risk of relapse/progression or death, 0.64; P < .001) and improved OS (relative risk of death, 0.74; P = .039). We conclude that pre-transplant rituximab is associated with a lower rate of progression and improved survival after AuHCT for DLBCL, with no evidence of impaired engraftment or increased NRM.

Author List

Fenske TS, Hari PN, Carreras J, Zhang MJ, Kamble RT, Bolwell BJ, Cairo MS, Champlin RE, Chen YB, Freytes CO, Gale RP, Hale GA, Ilhan O, Khoury HJ, Lister J, Maharaj D, Marks DI, Munker R, Pecora AL, Rowlings PA, Shea TC, Stiff P, Wiernik PH, Winter JN, Rizzo JD, van Besien K, Lazarus HM, Vose JM

Authors

Timothy Fenske MD Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin
J. Douglas D. Rizzo MD, MS Director, Ctr Associate Director, Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-70350587347   42 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Antibodies, Monoclonal
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols
Disease-Free Survival
Female
Graft Survival
Humans
Kaplan-Meier Estimate
Lymphoma, Large B-Cell, Diffuse
Male
Middle Aged
Peripheral Blood Stem Cell Transplantation
Premedication
Proportional Hazards Models
Recurrence
Remission Induction
Retrospective Studies
Rituximab
Salvage Therapy
Treatment Outcome
Young Adult
jenkins-FCD Prod-297 dff1a717c492f00bf6291286365f1f4fe95208f1