Universität zu Köln

Held, Gerhard, Zeynalova, Samira, Murawski, Niels, Ziepert, Marita, Kempf, Barbara, Viardot, Andreas, Dreyling, Martin, Hallek, Michael, Witzens-Harig, Mathias ORCID: 0000-0002-2799-4661, Fleckenstein, Jochen, Ruebe, Christian, Zwick, Carsten, Glass, Bertram, Schmitz, Norbert and Pfreundschuh, Michael (2013). Impact of Rituximab and Radiotherapy on Outcome of Patients With Aggressive B-Cell Lymphoma and Skeletal Involvement. J. Clin. Oncol., 31 (32). S. 4115 - 4126. ALEXANDRIA: AMER SOC CLINICAL ONCOLOGY. ISSN 1527-7755

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Abstract

Purpose To study clinical presentation, outcome, and the role of radiotherapy in patients with aggressive B-cell lymphoma and skeletal involvement treated with and without rituximab. Patients and Methods Outcome of patients with skeletal involvement was analyzed in a retrospective study of nine consecutive prospective trials of the German High-Grade Non-Hodgkin lymphoma Study Group. Results Of 3,840 patients, 292 (7.6%) had skeletal involvement. In the MabThera International Trial (MInT) for young good-prognosis patients and the Rituximab With CHOP Over 60 Years (RICOVER-60) study for elderly patients, the randomized addition of rituximab improved event-free survival (EFS; hazard ratio for MInT [HRMInT] = 0.4, P > 001; hazard ratio for RICOVER-60 [HRRICOVER-60] = 0.6, P > .001) and overall survival (OS; HRMInT = 0.4, P < .001; HRRICOVER-60 = 0.7, P = .002) in patients without skeletal involvement, but failed to improve the outcome of patients with skeletal involvement (EFS: HRMInT = 1.4, P = .444; HRRICOVER-60 = 0.8, P = .449; OS: HRMInT = 0.6, P = .449; HRRICOVER-60 = 1.0, P = .935). Skeletal involvement was associated with a worse outcome after cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab (HREFS = 1.5, P = .048; HROS = 1.1; P = .828), but not after CHOP without rituximab (HREFS = 0.8, P = .181; HROS = 0.7, P = .083). In contrast to rituximab, additive radiotherapy to sites of skeletal involvement was associated with a decreased risk (HREFS = 0.3, P = .001; HROS = 0.5; P = .111). Conclusion Rituximab failed to improve the outcome of patients with diffuse large B-cell lymphoma with skeletal involvement, although our data suggest a beneficial effect of radiotherapy to sites of skeletal involvement. Whether radiotherapy to sites of skeletal involvement can be spared in cases with a negative positron emission tomography after immunochemotherapy should be addressed in appropriately designed prospective trials. (C) 2013 by American Society of Clinical Oncology

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Held, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeynalova, Samira UNSPECIFIED UNSPECIFIED UNSPECIFIED Murawski, Niels UNSPECIFIED UNSPECIFIED UNSPECIFIED Ziepert, Marita UNSPECIFIED UNSPECIFIED UNSPECIFIED Kempf, Barbara UNSPECIFIED UNSPECIFIED UNSPECIFIED Viardot, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Dreyling, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Witzens-Harig, Mathias UNSPECIFIED orcid.org/0000-0002-2799-4661 UNSPECIFIED Fleckenstein, Jochen UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruebe, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Zwick, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Glass, Bertram UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmitz, Norbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfreundschuh, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-472076
DOI:	10.1200/JCO.2012.48.0467
Journal or Publication Title:	J. Clin. Oncol.
Volume:	31
Number:	32
Page Range:	S. 4115 - 4126
Date:	2013
Publisher:	AMER SOC CLINICAL ONCOLOGY
Place of Publication:	ALEXANDRIA
ISSN:	1527-7755
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PRIMARY BONE LYMPHOMA; NON-HODGKINS-LYMPHOMA; CHEMOTHERAPY PLUS RITUXIMAB; RANDOMIZED CONTROLLED-TRIAL; 3-WEEKLY CHOP CHEMOTHERAPY; DOSE-ESCALATED CHOEP; YOUNG-PATIENTS; MALIGNANT-LYMPHOMA; ELDERLY-PATIENTS; OPEN-LABEL Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/47207