title: Impact of pre-transplant rituximab on survival after autologous hematopoietic stem cell transplantation for diffuse large B cell lymphoma.
abstract: Incorporation of the anti-CD20 monoclonal antibody rituximab into front-line regimens to treat diffuse large B cell lymphoma (DLBCL) has resulted in improved survival. Despite this progress, however, many patients develop refractory or recurrent DLBCL and then undergo autologous hematopoietic stem cell transplantation (AuHCT). It is unclear to what extent pre-transplant exposure to rituximab affects outcomes after AuHCT. Outcomes of 994 patients receiving AuHCT for DLBCL between 1996 and 2003 were analyzed according to whether rituximab was (n = 176; +R cohort) or was not (n = 818; -R cohort) administered with front-line or salvage therapy before AuHCT. The +R cohort had superior progression-free survival (PFS; 50% vs 38%; P = .008) and overall survival (OS; 57% vs 45%; P = .006) at 3 years. Platelet and neutrophil engraftment were not affected by exposure to rituximab. Nonrelapse mortality (NRM) did not differ significantly between the 2 cohorts. In multivariate analysis, the +R cohort had improved PFS (relative risk of relapse/progression or death, 0.64; P < .001) and improved OS (relative risk of death, 0.74; P = .039). We conclude that pre-transplant rituximab is associated with a lower rate of progression and improved survival after AuHCT for DLBCL, with no evidence of impaired engraftment or increased NRM.
authors.affiliation: Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. tfenske@mcw.edu
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Osman
authors.initials: O
authors.lastname: Ilhan
authors.forename: H Jean
authors.initials: HJ
authors.lastname: Khoury
authors.forename: John
authors.initials: J
authors.lastname: Lister
authors.forename: Dipnarine
authors.initials: D
authors.lastname: Maharaj
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: Reinhold
authors.initials: R
authors.lastname: Munker
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Pecora
authors.forename: Philip A
authors.initials: PA
authors.lastname: Rowlings
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Shea
authors.forename: Patrick
authors.initials: P
authors.lastname: Stiff
authors.forename: Peter H
authors.initials: PH
authors.lastname: Wiernik
authors.forename: Jane N
authors.initials: JN
authors.lastname: Winter
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000706:statistics & numerical data*; D011292:Premedication; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab