Rituximab Maintenance Therapy After Autologous Stem-Cell Transplantation in Patients With Relapsed CD20+ Diffuse Large B-Cell Lymphoma: Final Analysis of the Collaborative Trial in Relapsed Aggressive Lymphoma

• Published in: Journal of clinical oncology Vol. 30; no. 36; pp. 4462 - 4469
• Main Authors: GISSELBRECHT, Christian, SCHMITZ, Norbert, SHPILBERG, Ofer, DÜHRSEN, Ulrich, HAGBERG, Hans, MA, David D, VIARDOT, Andreas, LOWENTHAL, Ray, BRIERE, Josette, SALLES, Gilles, MOSKOWITZ, Craig H, GLASS, Bertram, MOUNIER, Nicolas, SINGH GILL, Devinder, LINCH, David C, TRNENY, Marek, BOSLY, Andre, MILPIED, Noel J, RADFORD, John, KETTERER, Nicolas
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 20-12-2012
• Subjects: Adult; Aged; Antibodies, Monoclonal, Murine-Derived - adverse effects; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antigens, CD20 - biosynthesis; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Combined Modality Therapy; Disease Progression; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - methods; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - immunology; Lymphoma, Large B-Cell, Diffuse - pathology; Lymphoma, Large B-Cell, Diffuse - surgery; Maintenance Chemotherapy; Male; Medical sciences; Middle Aged; Original Reports; Rapid Communications; Recurrence; Remission Induction; Rituximab; Salvage Therapy; Survival Analysis; Transplantation, Autologous; Tumors; Young Adult; Antineoplastic agent; Human; Relapse; Stem cell; Hematopoietic cell; Rituximab; B cell neoplasm; Malignant hemopathy; Monoclonal antibody; Lymphoid neoplasm; Non Hodgkin lymphoma; Cancerology; Lymphoproliferative syndrome; Immunotherapy; Maintenance treatment; Autologous hematopoietic stem cell transplantation; Clinical trial; Diffuse large B cell lymphoma; Cancer; High malignancy
• ISSN: 0732-183X; 1527-7755; 1527-7755
• DOI: 10.1200/JCO.2012.41.9416

The standard treatment for relapsed diffuse large B-cell lymphoma (DLBCL) is salvage chemotherapy followed by high-dose therapy and autologous stem-cell transplantation (ASCT). The impact of maintenance rituximab after ASCT is not known.
In total, 477 patients with CD20(+) DLBCL who were in their first relapse or refractory to initial therapy were randomly assigned to one of two salvage regimens. After three cycles of salvage chemotherapy, the responding patients received high-dose chemotherapy followed by ASCT. Then, 242 patients were randomly assigned to either rituximab every 2 months for 1 year or observation.
After ASCT, 122 patients received rituximab, and 120 patients were observed only. The median follow-up time was 44 months. The 4-year event-free survival (EFS) rates after ASCT were 52% and 53% for the rituximab and observation groups, respectively (P = .7). Treatment with rituximab was associated with a 15% attributable risk of serious adverse events after day 100, with more deaths (six deaths v three deaths in the observation arm). Several factors affected EFS after ASCT (P < .05), including relapsed disease within 12 months (EFS: 46% v 56% for relapsed disease after 12 months), secondary age-adjusted International Prognostic Index (saaIPI) more than 1 (EFS: 37% v 61% for saaIPI < 1), and prior treatment with rituximab (EFS: 47% v 59% for no prior rituximab). A significant difference in EFS between women (63%) and men (46%) was also observed in the rituximab group. In the Cox model for maintenance, the saaIPI was a significant prognostic factor (P < .001), as was male sex (P = .01).
In relapsed DLBCL, we observed no difference between the control group and the rituximab maintenance group and do not recommend rituximab after ASCT.