scholarly journals Favourable outcomes of poor prognosis diffuse large B-cell lymphoma patients treated with dose-dense Rituximab, high-dose Methotrexate and six cycles of CHOP-14 compared to first-line autologous transplantation

2017 ◽  
Vol 178 (6) ◽  
pp. 927-935 ◽  
Author(s):  
Tim Strüßmann ◽  
Kristina Fritsch ◽  
Axel Baumgarten ◽  
Thomas Fietz ◽  
Monika Engelhardt ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Cell Lymphoma ◽  
Autologous Transplantation ◽  
B Cell Lymphoma ◽  
High Dose ◽  
First Line ◽  
Large B Cell Lymphoma ◽  
Dose Methotrexate ◽  
Dose Dense ◽  
Large B Cell

The Treatment of Diffuse Large B-cell Lymphoma with Poor Prognosis in the Rituximab Era – State of the Art and Future Perspectives

2010 ◽  
Vol 00 (04) ◽  
pp. 75
Author(s):  
Umberto Vitolo ◽  
Annalisa Chiappella ◽  
Chiara Frairia ◽  
Barbara Botto ◽  
◽  
...  
Keyword(s):  
B Cell ◽  
Poor Prognosis ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Phase Iii ◽  
High Dose ◽  
Phase Ii Trials ◽  
Large B Cell Lymphoma ◽  
Dose Dense ◽  
Large B Cell

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. The International Prognostic Index, gene profiling and early positron-emission tomography (PET) evaluation are important prognostic factors, each with a different role in predicting outcome. The addition of rituximab to standard chemotherapy – cyclophosphamide, doxorubicine, vincristine and prednisone (CHOP) – improved the outcome in elderly newly diagnosed DLBCL patients and in young patients with favourable prognostic profiles. The best treatment of young poorprognosis patients affected by DLBCL is controversial. Several phase II trials have demonstrated that the addition of rituximab to dose-dense chemotherapy CHOP14 or the addition of rituximab to high-dose chemotherapy (HDC) with peripheral stem cell transplantation were feasible and effective. The question of whether rituximab–HDC may be more effective compared with rituximab–dose-dense chemotherapy is under investigation in randomised phase III trials by major international groups. Novel therapeutic options should be investigated to increase the outcome in poor-prognosis DLBCL patients, both as single agents and in combination with standard therapy. Radioimmunotherapy, immunomodulating agents (IMiDs), dacetuzumab (SGN-40), mammalian target of rapamycin (mTOR) inihibitors, proteasome inhibitors, histone deacetylase inhibitors and anti-angiogenetic agents (anti-vascular endothelial growth factor [VEGF]) are under evaluation in clinical trials. The results will provide new insights into the treatment of DLBCL following poor prognosis.

scholarly journals Impact of High-Dose Methotrexate on the Outcome of Patients with Diffuse Large B-Cell Lymphoma and Skeletal Involvement

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2945
Author(s):  
Mélanie Mercier ◽  
Corentin Orvain ◽  
Laurianne Drieu La Rochelle ◽  
Tony Marchand ◽  
Christopher Nunes Gomes ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Skeletal Involvement ◽  
Large B Cell Lymphoma ◽  
Dose Methotrexate ◽  
The Impact ◽  
Large B Cell

Diffuse large B-cell lymphoma (DLBCL) with extra nodal skeletal involvement is rare. It is currently unclear whether these lymphomas should be treated in the same manner as those without skeletal involvement. We retrospectively analyzed the impact of combining high-dose methotrexate (HD-MTX) with an anthracycline-based regimen and rituximab as first-line treatment in a cohort of 93 patients with DLBCL and skeletal involvement with long follow-up. Fifty patients (54%) received upfront HD-MTX for prophylaxis of CNS recurrence (high IPI score and/or epidural involvement) or because of skeletal involvement. After adjusting for age, ECOG, high LDH levels, and type of skeletal involvement, HD-MTX was associated with an improved PFS and OS (HR: 0.2, 95% CI: 0.1–0.3, p < 0.001 and HR: 0.1, 95% CI: 0.04–0.3, p < 0.001, respectively). Patients who received HD-MTX had significantly better 5-year PFS and OS (77% vs. 39%, p <0.001 and 83 vs. 58%, p < 0.001). Radiotherapy was associated with an improved 5-year PFS (74 vs. 48%, p = 0.02), whereas 5-year OS was not significantly different (79% vs. 66%, p = 0.09). A landmark analysis showed that autologous stem cell transplantation was not associated with improved PFS or OS. The combination of high-dose methotrexate and an anthracycline-based immunochemotherapy is associated with an improved outcome in patients with DLBCL and skeletal involvement and should be confirmed in prospective trials.

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