Radioimmunotherapy for DLBCL: Clinical Outcomes Post-R-CHOP

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.

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]