title: Prolonged survival in poor-risk diffuse large B-cell lymphoma following front-line treatment with rituximab-supplemented, early-intensified chemotherapy with multiple autologous hematopoietic stem cell support: a multicenter study by GITIL (Gruppo Italiano Terapie Innovative nei Linfomi).
abstract: A prospective multicenter program was performed to evaluate the combination of rituximab and high-dose (hd) sequential chemotherapy delivered with multiple autologous peripheral blood progenitor cell (PBPC) support (R-HDS-maps regimen) in previously untreated patients with diffuse large B-cell lymphoma (DLB-CL) and age-adjusted International Prognostic Score (aaIPI) score 2-3. R-HDS-maps includes: (i) three APO courses; (ii) sequential administration of hd-cyclophosphamide (CY), hd-Ara-C, both supplemented with rituximab, hd-etoposide/cisplatin, PBPC harvests, following hd-CY and hd-Ara-C; (iii) hd-mitoxantrone (hd-Mito)/L-Pam + 2 further rituximab doses; (iv) involved-field radiotherapy. PBPC rescue was scheduled following Ara-C, etoposide/cisplatin and Mito/L-Pam. Between 1999 and 2004, 112 consecutive patients aged <65 years (74 score 2, 38 score 3) entered the study protocol. There were five early and two late toxic deaths. Overall 90 patients (80%) reached clinical remission (CR); at a median 48 months follow-up, 87 (78%) patients are alive, 82 (73%) in continuous CR, with 4 year overall survival (OS) and event-free survival (EFS) projections of 76% (CI 68-85%) and 73% (CI 64-81%), respectively. There were no significant differences in OS and EFS between subgroups with Germinal-Center and Activated B-cell phenotype. Thus, life expectancy of younger patients with aaIPI 2-3 DLB-CL is improved with the early administration of rituximab-supplemented intensive chemotherapy compared with the poor outcome following conventional chemotherapy.
authors.affiliation: Dip Medicina-Oncologia Sperimentale, Divisione Universitaria di Ematologia, Torino, Italy. corrado.tarella@unito.it
authors.forename: C
authors.initials: C
authors.lastname: Tarella
authors.forename: M
authors.initials: M
authors.lastname: Zanni
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authors.initials: M
authors.lastname: Di Nicola
authors.forename: C
authors.initials: C
authors.lastname: Patti
authors.forename: R
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authors.lastname: Calvi
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authors.initials: A
authors.lastname: Pescarollo
authors.forename: V
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authors.lastname: Zoli
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authors.lastname: Fornari
authors.forename: D
authors.initials: D
authors.lastname: Novero
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authors.initials: A
authors.lastname: Cabras
authors.forename: M
authors.initials: M
authors.lastname: Stella
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authors.initials: A
authors.lastname: Comino
authors.forename: D
authors.initials: D
authors.lastname: Remotti
authors.forename: M
authors.initials: M
authors.lastname: Ponzoni
authors.forename: D
authors.initials: D
authors.lastname: Caracciolo
authors.forename: M
authors.initials: M
authors.lastname: Ladetto
authors.forename: M
authors.initials: M
authors.lastname: Magni
authors.forename: L
authors.initials: L
authors.lastname: Devizzi
authors.forename: R
authors.initials: R
authors.lastname: Rosato
authors.forename: M
authors.initials: M
authors.lastname: Boccadoro
authors.forename: M
authors.initials: M
authors.lastname: Bregni
authors.forename: P
authors.initials: P
authors.lastname: Corradini
authors.forename: A
authors.initials: A
authors.lastname: Gallamini
authors.forename: I
authors.initials: I
authors.lastname: Majolino
authors.forename: S
authors.initials: S
authors.lastname: Mirto
authors.forename: A M
authors.initials: AM
authors.lastname: Gianni
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D036102:Peripheral Blood Stem Cell Transplantation; D011446:Prospective Studies; D000069283:Rituximab; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D003561:Cytarabine; D000069283:Rituximab; D005047:Etoposide; D003520:Cyclophosphamide; D008942:Mitoxantrone; D002945:Cisplatin; D008558:Melphalan