[en] Background The superiority of a chemotherapy with doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone (ACVBP) in comparaison with cyclophosphamide, doxorubicin, vincristin and prednisone plus radiotherapy for Young patients with localized diffuse large B-cell lymphoma (DLBCL) was previously demonstrated. We report the results of a trial which évaluâtes the role of rituximab combined with ACVBP (R- ACVBP) in these patients. Patients and methods untreated patients younger than 66 years with stage I or II DLBCL and no adverse prognostic factors of the age-adjusted International Prognostic Index were randomly assigned to receive three cycles of ACVBP plus sequential consolidation with or without the addition of four infusions of rituximab. Results a total of 223 patients were randomly allocated to the study, 110 in the R-ACVBP group and 113 in the ACVBP group. After a median follow-up of 43 months, our 3-year estimate of event-free survival was 93% in the R-ACVBP group and 82% in the ACVBP group (P=0.0487). Three-year estimate of progression-free survival was increased in the R-ACVBP group (95% versus 83%, P=0.0205). Overall survival did not differ between the two groups with a 3-year estimâtes of 98% and 97%, respectively (P=0.686). Conclusion in Young patients with low-risk localized DLBCL, rituximab combined with three cycles of ACVBP plus consolidation is significantly Superior to ACVBP plus consolidation alone.
Sweet DL, Kinzie J, Gaeke ME et al.. Survival of patients with localized diffuse histiocytic lymphoma. Blood 1981; 58: 1218-1223.
Connors JM, Klimo P, Fairey RN et al.. Brief chemotherapy and involved field radiation therapy for limited-stage, histologically aggressive lymphoma. Ann Intern Med 1987; 107: 25-30.
Cabanillas F, Bodey GP, Freireich EJ. Management with chemotherapy only of stage I and II malignant lymphoma of aggressive histologic types. Cancer 1980; 46: 2356-2359.
Miller TP, Dahlberg S, Cassady JR et al.. Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med 1998; 339: 21-26.
Reyes F, Lepage E, Ganem G et al.. ACVBP versus CHOP plus radiotherapy for localized aggressive lymphoma. N Engl J Med 2005; 352: 1197-1205.
Coiffier B, Lepage E, Briere J et al.. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002; 346: 235-242.
Pfreundschuh M, Trümper L, Osterborg A et al.. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with goodprognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 2006; 7: 379-391.
Swerdlow SH, Campo E, Harris NL et al.. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press 2008.
The International Non-Hodgkins Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkins lymphoma. N Engl J Med 1993; 329: 987-994.
Cheson BD, Horning SJ, Coiffier B et al.. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999; 17: 1244.
Miller TP, Leblanc M, Spier PM et al.. CHOP alone compared to CHOP plus radiotherapy for early stage aggressive non-Hodgkins lymphoma: update of the Southwest Oncology Group (SWOG) randomized trial. Blood 2001; 98(Suppl.): S742-S743.
Horning SJ, Weller E, Kim K et al.. Chemotherapy with or without radiotherapy in limited-stage diffuse aggressive non-Hodgkins lymphoma: Eastern Cooperative Oncology Group study 1484. J Clin Oncol 2004; 22: 3032-3038.
Bonnet C, Fillet G, Mounier N et al.. CHOP alone compared with CHOP plus radiotherapy for localized aggressive lymphoma in elderly patients: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol 2007; 25: 787-792.
Persky DO, Unger JM, Spier CM et al.. Phase II study of rituximab plus three cycles of CHOP and involved-field radiotherapy for patients with limited-stage aggressive B-cell lymphoma: Southwest Oncology Group study 0014. J Clin Oncol 2008; 26: 2258-2263.
Dunleavy K, Pittaluga S, Janik J et al.. Primary mediastinal large B-cell lymphoma (PMBL) outcome is significantly improved by the addition of rituximab to dose adjusted (DA)-EPOCH and overcomes the need for radiation. Blood 2005; 106(Suppl.): 929a.
Sehn LH, Berry B, Chhanabhai M et al.. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 2007; 109: 1857-1861.
Recher C, Coiffier B, Haioun C et al.. A prospective randomized study comparing dose intensive immuno-chemotherapy with R-ACVBP versus standard R-CHOP in younger patients with diffuse large B-cell lymphoma (DLBCL). Groupe d'Etude des Lymphomes de l'Adulte (GELA) Study LNH03-2B. Lancet 2011; 378: 1858-1867.
Pfreundschuh M, Zeynalova S, Poeschel V et al.. Improved outcome of elderly patients with poor-prognosis diffuse large B-cell lymphoma (DLBCL) after dosedense rituximab: results of the Dense-R-CHOP-14 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). J Clin Oncol 2008; 26: 8508a.