Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma
Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma
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DOI：
10.1182/blood-2003-11-3911
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发表时间：
2004-05-15
期刊：
影响因子：
20.3
通讯作者：
Moskowitz, CH
中科院分区：
文献类型：
--
作者：
Kewalramani, T;Zelenetz, AD;Moskowitz, CH
复发或原发难治性弥漫性大B细胞淋巴瘤(DLBCL)在自体干细胞移植(ASCT)前达到完全缓解(CR)的患者一般比仅达到部分缓解(PR)的患者预后更好。我们研究了在异环磷酰胺-卡铂-依托泊苷(ICE)化疗方案(赖斯)的基础上加用利妥昔单抗是否能增加考虑进行ASCT的DLBCL患者的CR率。36名符合条件的患者接受了莱斯治疗，34名患者接受了所有3个计划周期。完全缓解率为53%，明显好于连续接受ICE治疗的147例DLBCL患者的27%的完全缓解率(P=0.01)；完全缓解率为25%。发热中性粒细胞减少是最常见的3级或4级非血液毒性；它发生在7.5%的分娩周期。没有患者出现排除ASCT的大米相关毒性--每公斤动员的CD34(+)细胞的中位数为6.3x10(6)。赖斯术后接受移植的患者的无进展存活率略好于ICE后连续接受移植的95名历史对照组患者(2年时54%对43%；P=0.25)。赖斯似乎在复发和难治性DLBCL患者中诱导了非常高的CR率；然而，美国血液学学会还需要进一步的研究来确定这种治疗方案是否会改善2004年后的结果。
Patients with relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) who achieve complete response (CR) before autologous stem cell transplantation (ASCT) generally have better outcomes than those who achieve only partial response (PR). We investigated whether adding rituximab to the ifosfamide-carboplatin-etoposide (ICE) chemotherapy regimen (RICE) could increase the CR rate of patients with DLBCL under consideration for ASCT. Thirty-six eligible patients were treated with RICE, and 34 received all 3 planned cycles. The CR rate was 53%, significantly better than the 27% CR rate (P =.01) achieved among 147 similar consecutive historical control patients with DLBCL treated with ICE; the PR rate was 25%. Febrile neutropenia was the most frequent grade 3 or 4 nonhematologic toxicity; it occurred in 7.5% of delivered cycles. No patient had RICE-related toxicity that precluded ASCT- The median number of CD34(+) cells per kilogram mobilized was 6.3 x 10(6). Progression-free survival rates of patients who underwent transplantation after RICE were marginally better than those of 95 consecutive historical control patients who underwent transplantation after ICE (54% vs 43% at 2 years; P =.25). RICE appears to induce very high CR rates in patients with relapsed and refractory DLBCL; however, further studies are necessary to determine whether this treatment regimen will improve outcomes after (C) 2004 by The American Society of Hematology.