Response-adapted therapy with infusional EPOCH chemotherapy plus rituximab in HIV-associated, B-cell non-Hodgkin's lymphoma
| العنوان: | Response-adapted therapy with infusional EPOCH chemotherapy plus rituximab in HIV-associated, B-cell non-Hodgkin's lymphoma |
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| المؤلفون: | Ethel Cesarman, Jeannette Y. Lee, Joseph A. Sparano, Juan Carlos Ramos, Ronald T. Mitsuyasu, Ariela Noy, William Wachsman, Amy Chadburn, David H. Henry, Richard F. Ambinder, Lawrence D. Kaplan, Lee Ratner, David M. Aboulafia |
| المصدر: | Haematologica. 106:730-735 |
| بيانات النشر: | Ferrata Storti Foundation (Haematologica), 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Oncology, Vincristine, medicine.medical_specialty, Cyclophosphamide, medicine.medical_treatment, Immunology, CHOP, Biochemistry, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, immune system diseases, Prednisone, hemic and lymphatic diseases, Internal medicine, medicine, EPOCH (chemotherapy), Etoposide, 030304 developmental biology, 0303 health sciences, Chemotherapy, business.industry, Cell Biology, Hematology, medicine.disease, Chemotherapy regimen, Non-Hodgkin's lymphoma, 030220 oncology & carcinogenesis, Rituximab, Primary effusion lymphoma, business, Diffuse large B-cell lymphoma, Burkitt's lymphoma, medicine.drug |
| الوصف: | Introduction: Six cycles of rituximab plus infusional EPOCH is considered a preferred regimen for first-line treatment of HIV-associated diffuse large B-cell lymphoma (DLBCL), HHV8-positive DLBCL, and primary effusion lymphoma, and is among the preferred regimens for HIV-associated Burkitt's lymphoma in the 2019 NCCN guidelines. A phase III trial demonstrated non-inferiority of 4 cycles of R-CHOP (followed by 2 additional doses of rituximab) compared with 6 cycles of R-CHOP in immunocompetent patients with low-risk DLBCL (stage I-II, age 18-60 years, and an age-adjusted International Prognostic Index score of 0), indicating that de-escalation of treatment duration may be safely achieved without compromising curability in an appropriately selected patient population. Here we report the outcomes for patients with HIV-associated DLBCL and high-grade non-Hodgkin lymphoma (NHL) treated with 4-6 cycles of EPOCH plus rituximab based a response-adapted treatment strategy under a completed prospective clinical trial (AMC-034). Methods: One hundred-six patients with HIV-associated DLBCL or high-grade CD20-positive NHL enrolled at multiple centers across the U.S. were randomized to receive rituximab (375 mg/m2) given either concurrently prior to each infusional EPOCH cycle, or sequentially (weekly for 6 weeks) following completion of dose-adjusted EPOCH regimen tailored for HIV+ patients. EPOCH consisted of a 96-hour IV infusion of etoposide, doxorubicin, and vincristine plus oral prednisone followed by IV bolus cyclophosphamide every 21 days for 4 to 6 cycles. Patients received 2 additional cycles of therapy after documentation of a complete response (CR) by computerized tomography after cycles 2 and 4. Results: Sixty-four of 106 patients (60%, 95% CI 50%, 70%) had a CR in both treatment arms; characteristics of entire population and CR proportions stratified by number of EPOCH treatment cycles were similar (Table 1).The 2-year event-free survival (EFS) rates were similar in the 24 patients with CR who received 4 or fewer EPOCH cycles (78%, 95% confidence intervals [55%, 90%]) due to achieving a CR after 2 cycles, compared with those who received 5-6 cycles of EPOCH (85%, 95% CI 70%, 93%) due to failure to achieve a CR after 2 cycles (Table 2 and Figure 1). Time to disease progression and overall survival wer also similar for those treated with 4 or fewer cycles compared with 5-6 cycles (91% vs. 87%, and 78% vs. 90%, respectively) (Table 2 and Figure 1). Conclusion: A response-adapted strategy may permit a shorter treatment duration without compromising therapeutic efficacy in an appropriately selected population of patients with HIV-associated NHL, which merits further evaluation in additional prospective trials. Disclosures Noy: Janssen: Consultancy; Medscape: Honoraria; Prime Oncology: Honoraria; NIH: Research Funding; Pharamcyclics: Research Funding; Raphael Pharma: Research Funding. |
| تدمد: | 1592-8721 0390-6078 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b1ccfd7428e208175c04d7633da58616Test https://doi.org/10.3324/haematol.2019.243386Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....b1ccfd7428e208175c04d7633da58616 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15928721 03906078 |
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