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

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 ; Krohn, Thomas ; Raghavachar, Aruna ; Maschmeyer, Georg ; Brink, Ingo ; Schroers, Roland ; Gaska, Tobias ; Bernhard, Helga ; Giagounidis, Aristoteles ; Schütte, Jochen ; Dienst, Ariane ; Hautzel, Hubertus ; Naumann, Ralph ; Klein, Alfred ; Hahn, Dennis ; Pöpperl, Gabriele ; Grube, Matthias ; Marienhagen, Jörg ; Schwarzer, Andreas ; Kurch, Lars ; Höhler, Thomas ; Steiniger, Heike ; Nückel, Holger ; Südhoff, Thomas ; Römer, Wolfgang ; Brinkmann, Marcus ; Ose, Claudia ; Alashkar, Ferras ; Schmitz, Christine ; Dürig, Jan ; Hoelzer, Dieter ; Jöckel, Karl-Heinz ; Klapper, Wolfram ; Dührsen, Ulrich

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Details

Item type:	Article
Journal or Publication Title:	Annals of Hematology
Publisher:	Springer
Place of Publication:	NEW YORK
Volume:	98
Number of Issue or Book Chapter:	4
Page Range:	pp. 897-907
Date:	2019
Institutions:	Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) Medicine > Abteilung für Nuklearmedizin
Identification Number:	Value Type 10.1007/s00277-018-3578-0 DOI
Keywords:	FOLLICULAR LYMPHOMA; ELDERLY-PATIENTS; MAINTENANCE; MULTICENTER; CYCLOPHOSPHAMIDE; TRANSPLANTATION; CHEMOTHERAPY; PREDNISOLONE; VINCRISTINE; DOXORUBICIN; Diffuse large B cell lymphoma; Primary mediastinal B cell lymphoma; Follicular lymphoma; Rituximab; R-CHOP; Survival
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	48845

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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 ...

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 [F-18]-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 52months, 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 60years. 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.

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