R-CHOP with iodine-131 tositumomab consolidation for advanced stage diffuse large B-cell lymphoma (DLBCL): SWOG S0433

Jonathan W. Friedberg, Joseph M. Unger, W. Richard Burack, Ajay K. Gopal, Robert N. Raju, Auayporn P. Nademanee, Mark S. Kaminski, Hongli Li, Oliver W. Press, Thomas P Miller, Richard I. Fisher

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Summary: Radiolabelled antiCD-20 antibodies have demonstrated single agent activity in relapsed diffuse large B-cell lymphoma (DLBCL). The S0433 clinical trial enrolled patients with newly diagnosed, advanced stage or bulky stage II, histologically confirmed DLBCL. Patients received six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), two cycles of CHOP, then iodine-131 tositumomab radioimmunotherapy consolidation 30-60 d after completion of chemotherapy. The primary endpoint was 2-year progression-free survival (PFS). Eighty-four eligible patients were enrolled, and 56 patients completed the entire course of protocol treatment. Of the 84 patients evaluable for treatment response, 72 [86%, 95% confidence interval (CI): 76-92%] achieved a partial response (n = 21) or a confirmed (n = 41) or unconfirmed (n = 10) complete response to therapy. With a median follow-up of 3·9 years, the 2-year PFS estimate is 69% and the 2-year overall survival estimate is 77%. Rituximab levels at time of radioimmunotherapy did not correlate with toxicity or outcome. Twenty percent of patients had double hit features (MYC+; BCL2+) by immunohistochemistry, and had inferior outcome. These current results suggest that the incorporation of novel agents earlier in therapy may ultimately have greater impact in DLBCL, as early progressions, deaths and declining performance status during CHOP chemotherapy limited the number of patients who ultimately could benefit from radioimmunotherapy consolidation.

Original languageEnglish (US)
Pages (from-to)382-389
Number of pages8
JournalBritish Journal of Haematology
Volume166
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Lymphoma, Large B-Cell, Diffuse
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Radioimmunotherapy
Disease-Free Survival
Drug Therapy
Clinical Protocols
Secondary Prevention
Rituximab
iodine-131 anti-B1 antibody
Immunohistochemistry
Clinical Trials
Confidence Intervals
Survival
Antibodies
Therapeutics

Keywords

  • Chemotherapeutic approaches
  • Diffuse large B cell lymphoma
  • Lymphoma
  • Pharmacotherapeutics
  • Radioimmunotherapy

ASJC Scopus subject areas

  • Hematology

Cite this

Friedberg, J. W., Unger, J. M., Burack, W. R., Gopal, A. K., Raju, R. N., Nademanee, A. P., ... Fisher, R. I. (2014). R-CHOP with iodine-131 tositumomab consolidation for advanced stage diffuse large B-cell lymphoma (DLBCL): SWOG S0433. British Journal of Haematology, 166(3), 382-389. https://doi.org/10.1111/bjh.12906

R-CHOP with iodine-131 tositumomab consolidation for advanced stage diffuse large B-cell lymphoma (DLBCL) : SWOG S0433. / Friedberg, Jonathan W.; Unger, Joseph M.; Burack, W. Richard; Gopal, Ajay K.; Raju, Robert N.; Nademanee, Auayporn P.; Kaminski, Mark S.; Li, Hongli; Press, Oliver W.; Miller, Thomas P; Fisher, Richard I.

In: British Journal of Haematology, Vol. 166, No. 3, 2014, p. 382-389.

Research output: Contribution to journalArticle

Friedberg, JW, Unger, JM, Burack, WR, Gopal, AK, Raju, RN, Nademanee, AP, Kaminski, MS, Li, H, Press, OW, Miller, TP & Fisher, RI 2014, 'R-CHOP with iodine-131 tositumomab consolidation for advanced stage diffuse large B-cell lymphoma (DLBCL): SWOG S0433', British Journal of Haematology, vol. 166, no. 3, pp. 382-389. https://doi.org/10.1111/bjh.12906
Friedberg, Jonathan W. ; Unger, Joseph M. ; Burack, W. Richard ; Gopal, Ajay K. ; Raju, Robert N. ; Nademanee, Auayporn P. ; Kaminski, Mark S. ; Li, Hongli ; Press, Oliver W. ; Miller, Thomas P ; Fisher, Richard I. / R-CHOP with iodine-131 tositumomab consolidation for advanced stage diffuse large B-cell lymphoma (DLBCL) : SWOG S0433. In: British Journal of Haematology. 2014 ; Vol. 166, No. 3. pp. 382-389.
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abstract = "Summary: Radiolabelled antiCD-20 antibodies have demonstrated single agent activity in relapsed diffuse large B-cell lymphoma (DLBCL). The S0433 clinical trial enrolled patients with newly diagnosed, advanced stage or bulky stage II, histologically confirmed DLBCL. Patients received six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), two cycles of CHOP, then iodine-131 tositumomab radioimmunotherapy consolidation 30-60 d after completion of chemotherapy. The primary endpoint was 2-year progression-free survival (PFS). Eighty-four eligible patients were enrolled, and 56 patients completed the entire course of protocol treatment. Of the 84 patients evaluable for treatment response, 72 [86{\%}, 95{\%} confidence interval (CI): 76-92{\%}] achieved a partial response (n = 21) or a confirmed (n = 41) or unconfirmed (n = 10) complete response to therapy. With a median follow-up of 3·9 years, the 2-year PFS estimate is 69{\%} and the 2-year overall survival estimate is 77{\%}. Rituximab levels at time of radioimmunotherapy did not correlate with toxicity or outcome. Twenty percent of patients had double hit features (MYC+; BCL2+) by immunohistochemistry, and had inferior outcome. These current results suggest that the incorporation of novel agents earlier in therapy may ultimately have greater impact in DLBCL, as early progressions, deaths and declining performance status during CHOP chemotherapy limited the number of patients who ultimately could benefit from radioimmunotherapy consolidation.",
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AU - Burack, W. Richard

AU - Gopal, Ajay K.

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AU - Nademanee, Auayporn P.

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AU - Miller, Thomas P

AU - Fisher, Richard I.

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AB - Summary: Radiolabelled antiCD-20 antibodies have demonstrated single agent activity in relapsed diffuse large B-cell lymphoma (DLBCL). The S0433 clinical trial enrolled patients with newly diagnosed, advanced stage or bulky stage II, histologically confirmed DLBCL. Patients received six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), two cycles of CHOP, then iodine-131 tositumomab radioimmunotherapy consolidation 30-60 d after completion of chemotherapy. The primary endpoint was 2-year progression-free survival (PFS). Eighty-four eligible patients were enrolled, and 56 patients completed the entire course of protocol treatment. Of the 84 patients evaluable for treatment response, 72 [86%, 95% confidence interval (CI): 76-92%] achieved a partial response (n = 21) or a confirmed (n = 41) or unconfirmed (n = 10) complete response to therapy. With a median follow-up of 3·9 years, the 2-year PFS estimate is 69% and the 2-year overall survival estimate is 77%. Rituximab levels at time of radioimmunotherapy did not correlate with toxicity or outcome. Twenty percent of patients had double hit features (MYC+; BCL2+) by immunohistochemistry, and had inferior outcome. These current results suggest that the incorporation of novel agents earlier in therapy may ultimately have greater impact in DLBCL, as early progressions, deaths and declining performance status during CHOP chemotherapy limited the number of patients who ultimately could benefit from radioimmunotherapy consolidation.

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