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.
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.
Authors: Jennifer C Ho; Bouthaina S Dabaja; Sarah A Milgrom; Grace L Smith; Jay P Reddy; Ali Mazloom; Ken H Young; Lijuan Deng; L Jeffrey Medeiros; Wenli Dong; Pamela K Allen; Therese Y Andraos; Nathan H Fowler; Loretta J Nastoupil; Yasuhiro Oki; Luis E Fayad; Francesco Turturro; Sattva S Neelapu; Jason Westin; Fredrick B Hagemeister; Maria Alma Rodriguez; Chelsea C Pinnix Journal: Leuk Lymphoma Date: 2017-05-09
Authors: S M Hiniker; R T Hoppe; M L Dworkin; A L Jiang; R Von Eyben; M A Spinner; R H Advani; R Lowsky Journal: Bone Marrow Transplant Date: 2021-10-20 Impact factor: 5.483
Authors: Peter J Hosein; Jocelyn C Maragulia; Matthew P Salzberg; Oliver W Press; Thomas M Habermann; Julie M Vose; Martin Bast; Ranjana H Advani; Robert Tibshirani; Andrew M Evens; Nahida Islam; John P Leonard; Peter Martin; Andrew D Zelenetz; Izidore S Lossos Journal: Br J Haematol Date: 2014-01-27 Impact factor: 6.998
Authors: Alison K Yoder; Jillian R Gunther; Sarah A Milgrom; Dragan Mirkovic; Loretta Nastoupil; Sattva Neelapu; Michelle Fanale; Nathan Fowler; Jason Westin; Hun Ju Lee; M Alma Rodriguez; Swaminathan P Iyer; Luis Fayad; Yago L Nieto; Chitra Hosing; Sairah Ahmed; L Jeffrey Medeiros; Joseph D Khoury; Naveen Garg; Behrang Amini; Bouthaina S Dabaja; Chelsea C Pinnix Journal: Clin Lymphoma Myeloma Leuk Date: 2018-09-10