title: Survival impact of rituximab combined with ACVBP and upfront consolidation autotransplantation in high-risk diffuse large B-cell lymphoma for GELA.
abstract: BACKGROUND
  As rituximab combined with CHOP improves complete remission and overall survival in diffuse large B-cell lymphoma, intensified chemotherapy followed by autologous stem-cell transplantation has also been advocated for high-risk patients. The aim of this study was to establish whether or not combining rituximab with high-dose chemotherapy and auto-transplantation also benefits patient survival.
  
  
  METHODS
  The LNH2003-3 study was a phase II trial including diffuse large B-cell lymphoma patients with 2 or 3 International Prognostic Index factors. They received four cycles of intensive biweekly chemotherapy with rituximab, doxorubicine, cyclophosphamide, vindesine, bleomycine, prednisolone (R-ACVBP) followed by auto-transplantation in responding patients. Two hundred and nine patients under 60 years of age were included in the study and 155 responding patients underwent auto-transplantation. In addition, a case-control study was performed by matching (1:1) 181 patients treated with R-ACVBP with ACVBP patients not given rituximab but submitted to auto-transplantation from the previous LNH1998-3 trial.
  
  
  RESULTS
  With a median follow up of 45 months, 4-year progression-free survival and overall survival were estimated at 76% (CI: 69-81) and 78% (CI: 72-83), respectively. There was no difference between patients with 2 or 3 International Prognostic Index factors. Four year progression-free survival was significantly higher in R-ACVBP than ACVBP patients (74% vs. 58%; P=0.0005). There was also a significant increase in 4-year overall survival (76% vs. 68%; P=0.0494).
  
  
  CONCLUSIONS
  In high-risk diffuse large B-cell lymphoma patients, treatment with R-ACVBP followed by auto-transplantation results in a 78% 4-year overall survival which should be compared to other approaches.
authors.affiliation: Service Onco-Hématologie, Hôpital Saint Louis, 1 avenue Claude Vellefaux, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fitoussi
authors.forename: Karim
authors.initials: K
authors.lastname: Belhadj
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mounier
authors.forename: Marie
authors.initials: M
authors.lastname: Parrens
authors.forename: Hervé
authors.initials: H
authors.lastname: Tilly
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
authors.forename: Pierre
authors.initials: P
authors.lastname: Feugier
authors.forename: Christophe
authors.initials: C
authors.lastname: Ferme
authors.forename: Loic
authors.initials: L
authors.lastname: Ysebaert
authors.forename: Jean
authors.initials: J
authors.lastname: Gabarre
authors.forename: Raoul
authors.initials: R
authors.lastname: Herbrecht
authors.forename: Maud
authors.initials: M
authors.lastname: Janvier
authors.forename: Eric
authors.initials: E
authors.lastname: Van Den Neste
authors.forename: Franck
authors.initials: F
authors.lastname: Morschhauser
authors.forename: Olivier
authors.initials: O
authors.lastname: Casasnovas
authors.forename: Hervé
authors.initials: H
authors.lastname: Ghesquieres
authors.forename: Bruno
authors.initials: B
authors.lastname: Anglaret
authors.forename: Sabine
authors.initials: S
authors.lastname: Brechignac
authors.forename: Corinne
authors.initials: C
authors.lastname: Haioun
authors.forename: Christian
authors.initials: C
authors.lastname: Gisselbrecht
mesh_terms: D000293:Adolescent; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014751:Vindesine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001761:Bleomycin; D000069283:Rituximab; D004317:Doxorubicin; D003520:Cyclophosphamide; D014751:Vindesine; D011241:Prednisone