Impact of rituximab and radiotherapy on outcome of patients with aggressive B-Cell lymphoma and skeletal iInvolvement

• Verfasst von: Held, Gerhard Wolfgang [VerfasserIn]
• Verfasst von: Zeynalova, Samira [VerfasserIn]
• Verfasst von: Murawski, Niels [VerfasserIn]
• Verfasst von: Ziepert, Marita [VerfasserIn]
• Verfasst von: Kempf, Barbara [VerfasserIn]
• Verfasst von: Viardot, Andreas [VerfasserIn]
• Verfasst von: Dreyling, Martin [VerfasserIn]
• Verfasst von: Hallek, Michael [VerfasserIn]
• Verfasst von: Witzens-Harig, Mathias [VerfasserIn]
• Verfasst von: Fleckenstein, Jochen [VerfasserIn]
• Verfasst von: Rübe, Christian [VerfasserIn]
• Verfasst von: Zwick, Carsten [VerfasserIn]
• Verfasst von: Glass, Bertram [VerfasserIn]
• Verfasst von: Schmitz, Norbert [VerfasserIn]
• Verfasst von: Pfreundschuh, Michael [VerfasserIn]
• Titel: Impact of rituximab and radiotherapy on outcome of patients with aggressive B-Cell lymphoma and skeletal iInvolvement
• Verf.angabe: Gerhard Held, Samira Zeynalova, Niels Murawski, Marita Ziepert, Barbara Kempf, Andreas Viardot, Martin Dreyling, Michael Hallek, Mathias Witzens-Harig, Jochen Fleckenstein, Christian Rübe, Carsten Zwick, Bertram Glass, Norbert Schmitz, and Michael Pfreundschuh
• E-Jahr: 2013
• Jahr: September 23, 2013
• Umfang: 8 S.
• Teil: volume:31
• Teil: year:2013
• Teil: number:32
• Teil: pages:4115-4122
• Teil: extent:8
• Fussnoten: Gesehen am 31.03.2021
• Titel Quelle: Enthalten in: Journal of clinical oncology
• Ort Quelle: Alexandria, Va. : American Society of Clinical Oncology, 1983
• Jahr Quelle: 2013
• Band/Heft Quelle: 31(2013), 32, Seite 4115-4122
• ISSN Quelle: 1527-7755
• DOI: doi:10.1200/JCO.2012.48.0467
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1752982959

Abstract

Purpose To study clinical presentation, outcome, and the role of radiotherapy in patients with aggressive B-cell lymphoma and skeletal involvement treated with and without rituximab. Patients and Methods Outcome of patients with skeletal involvement was analyzed in a retrospective study of nine consecutive prospective trials of the German High-Grade Non-Hodgkin lymphoma Study Group. Results Of 3,840 patients, 292 (7.6%) had skeletal involvement. In the MabThera International Trial (MInT) for young good-prognosis patients and the Rituximab With CHOP Over 60 Years (RICOVER-60) study for elderly patients, the randomized addition of rituximab improved event-free survival (EFS; hazard ratio for MInT [HRMInT] = 0.4, P > 001; hazard ratio for RICOVER-60 [HRRICOVER-60] = 0.6, P > .001) and overall survival (OS; HRMInT = 0.4, P < .001; HRRICOVER-60 = 0.7, P = .002) in patients without skeletal involvement, but failed to improve the outcome of patients with skeletal involvement (EFS: HRMInT = 1.4, P = .444; HRRICOVER-60 = 0.8, P = .449; OS: HRMInT = 0.6, P = .449; HRRICOVER-60 = 1.0, P = .935). Skeletal involvement was associated with a worse outcome after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab (HREFS = 1.5, P = .048; HROS = 1.1; P = .828), but not after CHOP without rituximab (HREFS = 0.8, P = .181; HROS = 0.7, P = .083). In contrast to rituximab, additive radiotherapy to sites of skeletal involvement was associated with a decreased risk (HREFS = 0.3, P = .001; HROS = 0.5; P = .111). Conclusion Rituximab failed to improve the outcome of patients with diffuse large B-cell lymphoma with skeletal involvement, although our data suggest a beneficial effect of radiotherapy to sites of skeletal involvement. Whether radiotherapy to sites of skeletal involvement can be spared in cases with a negative positron emission tomography after immunochemotherapy should be addressed in appropriately designed prospective trials.