Updated Results of Rituximab Pre- and Post-BEAM with or without 90 Yttrium Ibritumomab Tiuxetan during Autologous Transplant for Diffuse Large B-cell Lymphoma

• Published in: Clinical cancer research 2018-05, Vol.24 (10), p.2304
• Main Authors: Chahoud, Jad, Sui, Dawen, Erwin, William D, Gulbis, Alison M, Korbling, Martin, Zhang, Mingzhi, Ahmed, Sairah, Alatrash, Gheath, Anderlini, Paolo, Ciurea, Stefan O, Oran, Betul, Fayad, Luis E, Bassett, Jr, Roland L, Jabbour, Elias J, Medeiros, L Jeffrey, Macapinlac, Homer A, Young, Ken H, Khouri, Issa F
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autografts; Biomarkers, Tumor; Carmustine - therapeutic use; Cause of Death; Clinical Trials, Phase II as Topic; Combined Modality Therapy; Cytarabine - therapeutic use; Disease-Free Survival; Etoposide - therapeutic use; Female; Graft Survival; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Humans; Kaplan-Meier Estimate; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - mortality; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Melphalan - therapeutic use; Middle Aged; Prognosis; Randomized Controlled Trials as Topic; Retreatment; Rituximab - administration & dosage; Rituximab - therapeutic use; Treatment Outcome; Young Adult; Yttrium Radioisotopes - administration & dosage
• ISSN: 1078-0432
• DOI: 10.1158/1078-0432.CCR-17-3561

We evaluated the effect on long-term survival of adding rituximab (R) to BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning with or without yttrium-90 ibritumomab tiuxetan ( YIT) in patients with relapsed diffuse large B-cell lymphoma (DLBCL) undergoing autologous stem cell transplant (ASCT). Patients were enrolled on three consecutive phase II clinical trials. Patients received two doses of rituximab (375 and 1,000 mg/m ) during mobilization of stem cells, followed by 1,000 mg/m on days +1 and +8 after ASCT with R-BEAM or YIT-R-BEAM ( YIT dose of 0.4 mCi/kg) conditioning. One hundred thirteen patients were enrolled, with 73 receiving R-BEAM and 40 receiving YIT-R-BEAM. All patients had a prior exposure to rituximab. The median follow-up intervals for survivors were 11.8, 8.1, and 4.2 years in the three trials, respectively. The 5-year disease-free survival (DFS) rates were 62% for R-BEAM and 65% for YIT-R-BEAM ( = 0.82). The 5-year overall survival rates were 73% and 77%, respectively ( = 0.65). In patients with DLBCL, survival outcomes of the germinal center/activated b-cell histologic subtypes were similar with 5-year OS rates ( = 0.52) and DFS rates ( = 0.64), irrespective of their time of relapse (1 year) after initial induction chemotherapy ( = 0.97). Administering ASCT with rituximab during stem cell collection and immediately after transplantation induces long-term disease remission and abolishes the negative prognostic impact of cell-of-origin in patients with relapsed DLBCL. The addition of YIT does not confer a further survival benefit. .