Intensified Immunochemotherapy Benefits B-Cell Lymphoma

Intensified immunochemotherapy ups overall, event, progression-free survival in large B-cell lymphoma

TUESDAY, Nov. 29 (HealthDay News) -- For patients with untreated diffuse large B-cell lymphoma, intensified immunochemotherapy with rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP) is associated with improved survival compared to standard therapy with rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisone (R-CHOP), according to a study published in the Nov. 26 issue of The Lancet.

Christian Récher, M.D., from the Centre Hospitalier Universitaire de Toulouse in France, and colleagues compared the potential survival benefit of R-ACVBP with subsequent consolidation and standard R-CHOP, in 18- to 59-year old patients with untreated diffuse large B-cell lymphoma, and an age-adjusted international prognostic index equal to 1. A total of 196 and 184 patients were randomized to receive R-ACVBP and R-CHOP therapy, respectively. One patient withdrew consent to participate (from the R-CHOP group), and 54 patients did not complete treatment. Event-free survival was the primary end point, measured during a median follow-up of 44 months.

The investigators found that the three year event-free survival estimate was 81 and 67 percent in the R-ACVBP and R-CHOP groups, respectively (hazard ratio [HR], 0.56). The corresponding three-year progression-free survival estimates were 87 and 73 percent, respectively (HR, 0.48), and overall survival estimates were 92 and 84 percent, respectively (HR, 0.44). Serious adverse events were found in 42 and 15 percent of patients in the R-ACVBP and R-CHOP groups, respectively. The R-ACVBP group experienced grade 3 to 4 hematological toxic effects more frequently than the R-CHOP group, and had a higher proportion of patients experiencing a febrile neutropenic episode.

"Intensified immunochemotherapy with R-ACVBP represents an alternative to R-CHOP to improve survival," the authors write.

Several authors disclosed financial relationships with pharmaceutical companies, including Amgen, which partially funded the study.

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