title: A phase II trial of RCHOP followed by radioimmunotherapy for early stage (stages I/II) diffuse large B-cell non-Hodgkin lymphoma: ECOG3402.
abstract: Patients with early stage diffuse large B-cell lymphoma (DLBCL) receive RCHOP (rituximab cyclophosphamide, doxorubicin, vincristine, prednisone) alone or with involved field radiotherapy (IFRT). Anti-CD20 radioimmunotherapy (RIT) delivers radiation to microscopic sites outside of known disease. This phase II study aimed to achieve a functional complete response (CR) rate of ≥75% to RCHOP and (90) Yttrium-ibritumomab tiuxetan RIT. Patients with stages I/II DLBCL received 4-6 cycles of RCHOP followed by RIT [14·8 MBq/kg (0·4 mCi/kg)]; patients with positron emission tomographypositive sites of disease after RCHOP/RIT received 30 Gy IFRT. Of the 62 patients enrolled; 53 were eligible. 42% (22/53) had stage I/IE; 58% (31/53) stage II/IIE. After RCHOP, 79% (42/53) were in CR/unconfirmed CR. Forty-eight patients proceeded to RIT. One partial responder after RIT received IFRT and achieved a CR. The best response after RCHOP + RIT in all 53 patients was a functional CR rate of 89% (47/53; 95% confidence interval: 77-96%). With a median follow-up of 5·9 years, 7 (13%) patients have progressed and 4 (8%) have died (2 with DLBCL). At 5 years, 78% of patients remain in remission and 94% are alive. Chemoimmunotherapy and RIT is an active regimen for early stage DLBCL patients. Eighty-nine percent of patients achieved functional CR without the requirement of IFRT. This regimen is worthy of further study for early stage DLBCL in a phase III trial.
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.affiliation: Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Fangxin
authors.initials: F
authors.lastname: Hong
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Ivana N
authors.initials: IN
authors.lastname: Micallef
authors.affiliation: British Columbia Cancer Agency, Centre for Lymphoid Cancer, Vancouver, BC, Canada.
authors.forename: Randy D
authors.initials: RD
authors.lastname: Gascoyne
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dogan
authors.affiliation: Penn State Cancer Institute, Hershey, PA, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Wagner
authors.affiliation: University of Wisconsin, Madison, WI, USA.
authors.forename: Brad S
authors.initials: BS
authors.lastname: Kahl
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: Ranjana H
authors.initials: RH
authors.lastname: Advani
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Horning
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D000069283:Rituximab; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; C422802:ibritumomab tiuxetan; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: R-CHOP; large cell lymphoma; radioimmunotherapy