RITUXIMAB FOR LOW RISC DLBCL 

NEW YORK (Reuters Health) Jan 04 - Progression-free survival in younger patients with low-risk localized diffuse large B-cell lymphoma (DLBCL) is better when rituximab is added to a chemotherapy regimen currently considered optimal, a European team reports.

The best chemotherapy for localized low-risk DLBCL isn't absolutely clear, however. "The majority of these patients are currently cured with rituximab-containing chemotherapy regimens, and whether some of them could benefit safely from a decreased treatment intensity remains to be determined," they wrote in a report online December 12 in Annals of Oncology.

In a phase III trial, Dr. Nicolas Ketterer, at Clinique Bois-Cerf in Lausanne, Switzerland, and colleagues tested the effect of adding rituximab to the so-called ACVBP regimen (doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone), which they say is superior to the previous standard of radiation plus CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) for young patients with DLBCL.

Altogether, 223 patients younger than 66 with stage I or II DLBCL received three cycles of ACVBP with or without four infusions of rituximab, plus sequential consolidation.

The researchers say they failed to meet their original enrollment target of 400 patients, probably because doctors became increasingly reluctant to treat without rituximab. Still, "a longer follow-up allowed this study to keep its 90% power and the expected level of significance despite a smaller patient population."

With a median follow-up of 43 months, the estimated three-year event-free survival was 93% in the ACVBP-plus-rituximab group compared to 82% in the ACVBP-only group (p=0.0487), the investigators found.

Corresponding three-year progression-free survival rates with vs without rituximab were 95% vs 83% (p=0.0205), respectively.

Still, there was no difference in overall survival, "with 98% and 97% of the patients being alive in the respective groups," Dr. Ketterer and colleagues report.

They conclude that randomized trials are needed to test reduced intensity regimens. "Moreover," they add, "it could be anticipated that PET-CT may represent an important tool to tailor more precisely the best treatment in this setting."

The authors of the report did not respond to a request for comment.

SOURCE: http://bit.ly/134h9tQ

Ann Oncol 2012.