Six versus eight doses of rituximab in patients with aggressive B cell lymphoma receiving six cycles of CHOP: results from the “Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas” (PETAL) trial

Standard first-line treatment of aggressive B cell lymphoma comprises six or eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus eight doses of rituximab (R). Whether adding two doses of rituximab to six cycles of R-CHOP is of therapeutic benefit has not been syste...

Full description

Saved in:
Bibliographic Details
Published in:Annals of hematology 2019-04, Vol.98 (4), p.897-907
Main Authors: Hüttmann, Andreas, Rekowski, Jan, Müller, Stefan P., Hertenstein, Bernd, Franzius, Christiane, Mesters, Rolf, Weckesser, Matthias, Kroschinsky, Frank, Kotzerke, Jörg, Ganser, Arnold, Bengel, Frank M., La Rosée, Paul, Freesmeyer, Martin, Höffkes, Heinz-Gert, Hertel, Andreas, Behringer, Dirk, Prange-Krex, Gabriele, Griesshammer, Martin, Holzinger, Jens, Wilop, Stefan, Krohn, Thomas, Raghavachar, Aruna, Maschmeyer, Georg, Brink, Ingo, Schroers, Roland, Gaska, Tobias, Bernhard, Helga, Giagounidis, Aristoteles, Schütte, Jochen, Dienst, Ariane, Hautzel, Hubertus, Naumann, Ralph, Klein, Alfred, Hahn, Dennis, Pöpperl, Gabriele, Grube, Matthias, Marienhagen, Jörg, Schwarzer, Andreas, Kurch, Lars, Höhler, Thomas, Steiniger, Heike, Nückel, Holger, Südhoff, Thomas, Römer, Wolfgang, Brinkmann, Marcus, Ose, Claudia, Alashkar, Ferras, Schmitz, Christine, Dürig, Jan, Hoelzer, Dieter, Jöckel, Karl-Heinz, Klapper, Wolfram, Dührsen, Ulrich
Format: Article
Language:English
Subjects:
Hematology
Immunotherapy
Lymphoma
Medicine
Medicine & Public Health
Monoclonal antibodies
Oncology
Original Article
Targeted cancer therapy
Tomography
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Standard first-line treatment of aggressive B cell lymphoma comprises six or eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus eight doses of rituximab (R). Whether adding two doses of rituximab to six cycles of R-CHOP is of therapeutic benefit has not been systematically investigated. The Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL) trial investigated the ability of [ 18 F]-fluorodesoxyglucose PET scanning to guide treatment in aggressive non-Hodgkin lymphomas. Patients with B cell lymphomas and a negative interim scan received six cycles of R-CHOP with or without two extra doses of rituximab. For reasons related to trial design, only about a third underwent randomization between the two options. Combining randomized and non-randomized patients enabled subgroup analyses for diffuse large B cell lymphoma (DLBCL; n  = 544), primary mediastinal B cell lymphoma (PMBCL; n  = 37), and follicular lymphoma (FL) grade 3 ( n  = 35). With a median follow-up of 52 months, increasing the number of rituximab administrations failed to improve outcome. A non-significant trend for improved event-free survival was seen in DLBCL high-risk patients, as defined by the International Prognostic Index, while inferior survival was observed in female patients below the age of 60 years. Long-term outcome in PMBCL was excellent. Differences between FL grade 3a and FL grade 3b were not apparent. The results were confirmed in a Cox proportional hazard regression model and a propensity score matching analysis. In conclusion, adding two doses of rituximab to six cycles of R-CHOP did not improve outcome in patients with aggressive B cell lymphomas and a fast metabolic treatment response.
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-018-3578-0