title: Treatment of high-risk aggressive B-cell non-Hodgkin lymphomas with rituximab, intensive induction and high-dose consolidation: long-term analysis of the R-MegaCHOP-ESHAP-BEAM Trial.
abstract: We have studied the feasibility and efficacy of intensified R-MegaCHOP-ESHAP-BEAM therapy in high-risk aggressive B-cell lymphomas. Altogether 105 patients (19-64 years) with diffuse large B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma (PMBL) or follicular lymphoma grade 3 (FL3) with an age-adjusted International Prognostic Index of 2-3 were recruited. Treatment consisted of three cycles of high-dose R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), followed by three cycles of R-ESHAP (rituximab, etoposide, methylprednisolone, cytarabine, cisplatin) and high-dose consolidation with BEAM (BCNU, etoposide, cytarabine, melphalan) and autologous stem cell transplant. The 5-year progression-free survival (PFS) was 72% (DLBCL 60%, PMBL 89%) and overall survival (OS) was 74% (DLBCL 61%, PMBL 89%) after a median follow-up of 85 months. However, an independent prognostic factor was age only, with patients ≤ 45 years having 5-year PFS 90% and patients > 45 years having PFS 54%. PMBL had better prognosis than DLBCL/FL3 in patients > 45 years (PFS, 88% vs. 48%), but not in younger patients (PFS, 91% vs. 94%).
authors.affiliation: First Department of Medicine, General University Hospital and First Medical Faculty, Charles University , Prague , Czech Republic.
authors.forename: Robert
authors.initials: R
authors.lastname: Pytlík
authors.forename: David
authors.initials: D
authors.lastname: Belada
authors.forename: Kateřina
authors.initials: K
authors.lastname: Kubáčková
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vášová
authors.forename: Tomáš
authors.initials: T
authors.lastname: Kozák
authors.forename: Jan
authors.initials: J
authors.lastname: Pirnos
authors.forename: Ingrid
authors.initials: I
authors.lastname: Bolomská
authors.forename: Milan
authors.initials: M
authors.lastname: Matuška
authors.forename: Jana
authors.initials: J
authors.lastname: Přibylová
authors.forename: Vít
authors.initials: V
authors.lastname: Campr
authors.forename: Lucie
authors.initials: L
authors.lastname: Burešová
authors.forename: Alice
authors.initials: A
authors.lastname: Sýkorová
authors.forename: Adéla
authors.initials: A
authors.lastname: Berková
authors.forename: Pavel
authors.initials: P
authors.lastname: Klener
authors.forename: Marek
authors.initials: M
authors.lastname: Trněný
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002330:Carmustine / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D060830:Consolidation Chemotherapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008558:Melphalan / Q000009:adverse effects / Q000627:therapeutic use; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011034:Podophyllotoxin / Q000009:adverse effects / Q000627:therapeutic use; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D003561:Cytarabine; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011034:Podophyllotoxin; D002945:Cisplatin; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone; D008775:Methylprednisolone
keywords: B cells; Lymphomas; chemotherapy; immunotherapy; transplant