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- Title
Six versus eight doses of rituximab in patients with aggressive B cell lymphoma receiving six cycles of CHOP: results from the "Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas" (PETAL) trial.
- Authors
Hüttmann, Andreas; Rekowski, Jan; Müller, Stefan P.; Hertenstein, Bernd; Franzius, Christiane; Mesters, Rolf; Weckesser, Matthias; Kroschinsky, Frank; Kotzerke, Jörg; Ganser, Arnold; Bengel, Frank M.; La Rosée, Paul; Freesmeyer, Martin; Höffkes, Heinz-Gert; Hertel, Andreas; Behringer, Dirk; Prange-Krex, Gabriele; Griesshammer, Martin; Holzinger, Jens; Wilop, Stefan
- Abstract
Standard first-line treatment of aggressive B cell lymphoma comprises six or eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus eight doses of rituximab (R). Whether adding two doses of rituximab to six cycles of R-CHOP is of therapeutic benefit has not been systematically investigated. The Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL) trial investigated the ability of [18F]-fluorodesoxyglucose PET scanning to guide treatment in aggressive non-Hodgkin lymphomas. Patients with B cell lymphomas and a negative interim scan received six cycles of R-CHOP with or without two extra doses of rituximab. For reasons related to trial design, only about a third underwent randomization between the two options. Combining randomized and non-randomized patients enabled subgroup analyses for diffuse large B cell lymphoma (DLBCL; n = 544), primary mediastinal B cell lymphoma (PMBCL; n = 37), and follicular lymphoma (FL) grade 3 (n = 35). With a median follow-up of 52 months, increasing the number of rituximab administrations failed to improve outcome. A non-significant trend for improved event-free survival was seen in DLBCL high-risk patients, as defined by the International Prognostic Index, while inferior survival was observed in female patients below the age of 60 years. Long-term outcome in PMBCL was excellent. Differences between FL grade 3a and FL grade 3b were not apparent. The results were confirmed in a Cox proportional hazard regression model and a propensity score matching analysis. In conclusion, adding two doses of rituximab to six cycles of R-CHOP did not improve outcome in patients with aggressive B cell lymphomas and a fast metabolic treatment response.
- Subjects
B cells; ANTINEOPLASTIC agents; B cell lymphoma; COMPARATIVE studies; DEOXY sugars; DOXORUBICIN; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PREDNISONE; PROGNOSIS; RADIOPHARMACEUTICALS; RESEARCH; RESEARCH funding; POSITRON emission tomography; VINCRISTINE; EVALUATION research; RANDOMIZED controlled trials; CYCLOPHOSPHAMIDE
- Publication
Annals of Hematology, 2019, Vol 98, Issue 4, p897
- ISSN
0939-5555
- Publication type
journal article
- DOI
10.1007/s00277-018-3578-0