Radioimmunotherapy for DLBCL: Clinical Outcomes Post-R-CHOP

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Elderly patients with diffuse large B-cell lymphoma ineligible for transplantation may benefit from radioimmunotherapy after chemoimmunotherapy.
Elderly patients with diffuse large B-cell lymphoma ineligible for transplantation may benefit from radioimmunotherapy after chemoimmunotherapy.

Elderly patients with diffuse large B-cell lymphoma (DLBCL) ineligible for transplantation may benefit from radioimmunotherapy after chemoimmunotherapy, according to an article published in The Lancet Haematology.1

The standard therapy for this patient population is rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The cure rate for elderly patients, however, remains low; researchers therefore evaluated whether radioimmunotherapy using 90Y-epratuzumab tetraxetan, an anti-CD22 monoclonal antibody, improved clinical outcomes for treatment-naive patients with DLBCL.

Seventy-one patients aged 60 to 80 years were enrolled and evaluated in this phase 2 trial (ClinicalTrials.gov Identifier: NCT00906841), in which patients who responded to 6 cycles of R-CHOP received 2 doses of fractionated 90Y-epratuzumab tetraxetan 6-8 weeks post-R-CHOP. The primary endpoint was 2-year survival, though the prognostic value of 18fluorodeoxyglucose (FDG-PET) was also evaluated.

Eighty percent of the evaluated patients received radioimmunotherapy; at a median 37 months' follow-up, 2-year event free survival was 75%.

FDG-PET in between R-CHOP and radioimmunotherapy was not of prognostic value, though PET post-radioimmunotherapy predicted better survival for PET-negative patients than for PET-positive patients (95% vs 53%, respectively). Albumin concentration also appeared to be a prognostic factor.

RELATED: Obinutuzumab-based Therapy Prolongs PFS in Untreated Follicular Lymphoma

Grade 3-4 thrombocytopenia and neutropenia were the most common adverse events among radioimmunotherapy-treated patients.

The authors concluded that 90Y-epratuzumab tetraxetan may be an effective consolidation therapy for elderly patients with DLBCL post-R-CHOP, though further research is needed.

Reference

  1. Kraeber-Bodere F, Pallardy A, Maisonneuve H, et al. Consolidation anti-CD22 fractionated radioimmunotherapy with 90Y-epratuzumab tetraxetan following R-CHOP in elderly patients with diffuse large B-cell lymphoma: a prospective, single group, phase 2 trial. Lancet Haematol. 2016 Dec 7. doi: 10.1016/S2352-3026(16)30168-5 [Epub ahead of print] 

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