title: Upfront consolidation combining yttrium-90 ibritumomab tiuxetan and high-dose therapy with stem cell transplantation in poor-risk patients with diffuse large B cell lymphoma.
abstract: We evaluated the safety and efficacy of standard-dose yttrium-90 (Y(90)) ibritumomab tiuxetan combined with high-dose BEAM (carmustine, etoposide, cytarabine, and melphalan) after first-line induction treatment in young patients with poor prognoses diffuse large B cell lymphoma (DLBCL) (clinicaltrials.gov: NCT00689169). Seventy-five high-risk (≥2 International Prognostic Index [IPI] factors) consecutive DLBCL patients (≤65 years old) in complete remission (CR) or partial remission (PR) after rituximab chemotherapy were treated with Y(90) ibritumomab tiuxetan and BEAM regimen followed by autologous stem cell transplantation (ASCT). The median follow-up was 34 months. Of the 75 patients, 71 underwent ASCT and were eligible for analysis. Median time to reach a neutrophil count of >500/μL and platelet count of >20,000/μL was 11 days. Mucositis ≥3 (51%) occurred in most patients. Other adverse events were similar to those seen with BEAM alone. The overall response rate was 86%; 59 patients (83%) achieved a CR or unconfirmed CR. The 2-year event-free survival (EFS), overall survival (OS), and disease-free survival were 79%, 83%, and 91%, respectively. Disease status (CR/PR) and positron emission tomography (PET) findings before transplantation did not predict treatment failure. The IPI (2 versus >2) and maximum tumor diameter of ≥10 cm at diagnosis appeared to be prognosis factors for OS but not for EFS. Adding Y(90) ibritumomab tiuxetan to BEAM is safe and does not increase transplantation-related toxicity. First-line consolidation with Y(90) ibritumomab tiuxetan and high-dose chemotherapy induced high rates of EFS and OS in poor-prognosis patients with DLBCL, regardless of PET status after induction treatment and warrants a randomized study.
authors: Centre François Baclesse, Department of Hematology, Caen, France. Electronic address: c.fruchart@baclesse.fr.
authors: Christophe
authors: C
authors: Fruchart
authors: Centre Henri Becquerel, Rouen, France.
authors: Hervé
authors: H
authors: Tilly
authors: CHU, Lille, France.
authors: Franck
authors: F
authors: Morschhauser
authors: Centre Léon Bérard, Lyon, France.
authors: Hervé
authors: H
authors: Ghesquières
authors: Hospices Civils de Lyon, France.
authors: Marie
authors: M
authors: Bouteloup
authors: Institut Gustave Roussy, Villejuif, France.
authors: Christophe
authors: C
authors: Fermé
authors: A.Z St. Jan, Brugge, Belgium.
authors: Eric
authors: E
authors: Van Den Neste
authors: CHU, Limoges, France.
authors: Dominique
authors: D
authors: Bordessoule
authors: Institut Paoli Calmette, Marseille, France.
authors: Reda
authors: R
authors: Bouabdallah
authors: CHU, Reims, France.
authors: Alain
authors: A
authors: Delmer
authors: CHU, Dijon, France.
authors: René Olivier
authors: RO
authors: Casasnovas
authors: CHU, Toulouse, France.
authors: Loïc
authors: L
authors: Ysebaert
authors: Médecine Nucléaire, Centre François Baclesse, Caen, France.
authors: Renaud
authors: R
authors: Ciappuccini
authors: INSERM U728, Institut Universitaire d'Hématologie, Paris, France.
authors: Josette
authors: J
authors: Briere
authors: Hôpital St Louis, Paris, France.
authors: Christian
authors: C
authors: Gisselbrecht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D064592:Autografts; D002330:Carmustine / Q000008:administration & dosage; D060830:Consolidation Chemotherapy; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D011034:Podophyllotoxin / Q000008:administration & dosage; D011446:Prospective Studies; D012307:Risk Factors; D000069283:Rituximab; D033581:Stem Cell Transplantation; D015996:Survival Rate
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D003561:Cytarabine; D000069283:Rituximab; C422802:ibritumomab tiuxetan; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine
keywords: 90Y-ibritumomab tiuxetan; BEAM regimen; Diffuse large B cell lymphoma (DLBCL); Transplantation