Impact of Pre-transplant Rituximab on Survival after Autologous Hematopoietic Stem Cell Transplantation for Diffuse Large B Cell Lymphoma
Year: 2009
Type: article
Study design: Observational Study
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.
Authors: Timothy S. Fenske, Parameswaran N. Hari, Jeanette Carreras, Mei-Jie Zhang, Rammurti T. Kamble, Brian J. Bolwell, Mitchell S. Cairo, Richard E. Champlin, Yi-Bin Chen, César O. Freytes, Robert Peter Gale, Gregory A. Hale, Osman Ilhan, H. Jean Khoury, John Lister, Dipnarine Maharaj, David I. Marks, Reinhold Munker, Andrew L. Pecora, Philip A. Rowlings, Thomas C. Shea, Patrick Stiff, Peter H. Wiernik, Jane N. Winter, J. Douglas Rizzo, Koen van Besien, Hillard M. Lazarus, Julie M. Vose
Institutions: Medical College of Wisconsin, Baylor College of Medicine, Cleveland Clinic, NewYork–Presbyterian Hospital, The University of Texas MD Anderson Cancer Center, Harvard University, Massachusetts General Hospital, The University of Texas at San Antonio Health Science Center, South Texas Veterans Health Care System, Celgene (United States), Johns Hopkins University, Johns Hopkins All Children's Hospital, Centre Hospitalier Ibn Sina, Emory University, Winship Cancer Institute, Western Pennsylvania Hospital, Maharaj Institute of Immune Regenerative Medicine, Louisiana State University, Louisiana State University Health Sciences Center Shreveport, Rutgers, The State University of New Jersey, Hackensack University Medical Center, Calvary Mater Newcastle Hospital, University of Newcastle Australia, University of North Carolina at Chapel Hill, Loyola University Chicago, Loyola Medicine, Montefiore Medical Center, New York Medical College, Northwestern University, Northwestern Memorial Hospital, University of Chicago, University of Chicago Medical Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, University of Nebraska Medical Center
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2092586894