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R-CHOP-14 versus R-CHOP-14/CHASER for upfront autologous transplantation in diffuse large B-cell lymphoma: JCOG0908 study.

Authors :
Kagami Y
Yamamoto K
Shibata T
Tobinai K
Imaizumi Y
Uchida T
Shimada K
Minauchi K
Fukuhara N
Kobayashi H
Yamauchi N
Tsujimura H
Hangaishi A
Tominaga R
Suehiro Y
Yoshida S
Inoue Y
Suzuki S
Tokuhira M
Kusumoto S
Kuroda J
Yakushijin Y
Takamatsu Y
Kubota Y
Nosaka K
Morishima S
Nakamura S
Ogura M
Maruyama D
Hotta T
Morishima Y
Tsukasaki K
Nagai H
Source :
Cancer science [Cancer Sci] 2020 Oct; Vol. 111 (10), pp. 3770-3779. Date of Electronic Publication: 2020 Sep 11.
Publication Year :
2020

Abstract

The efficiency of upfront consolidation with high-dose chemotherapy/autologous stem-cell transplantation (HDCT/ASCT) for newly diagnosed high-risk diffuse large B-cell lymphoma (DLBCL) may be influenced by induction chemotherapy. To select better induction chemotherapy regimens for HDCT/ASCT, a randomized phase II study was conducted in high-risk DLBCL patients having an age-adjusted International Prognostic Index (aaIPI) score of 2 or 3. As induction chemotherapy, 6 cycles of R-CHOP-14 (arm A) or 3 cycles of R-CHOP-14 followed by 3 cycles of CHASER (arm B) were planned, and patients who responded proceeded to HDCT with LEED and ASCT. The primary endpoint was 2-y progression-free survival (PFS), and the main secondary endpoints included overall survival, overall response rate, and adverse events (AEs). In total, 71 patients were enrolled. With a median follow-up of 40.3 mo, 2-y PFS in arms A and B were 68.6% (95% confidence interval [CI], 50.5%-81.2%) and 66.7% (95% CI: 48.8%-79.5%), respectively. Overall survival at 2 y in arms A and B was 74.3% (95% CI: 56.4%-85.7%) and 83.3% (95% CI: 66.6%-92.1%). Overall response rates were 82.9% in arm A and 69.4% in arm B. During induction chemotherapy, 45.7% and 75.0% of patients in arms A and B, respectively, had grade ≥ 3 non-hematologic toxicities. One patient in arm A and 6 in arm B discontinued induction chemotherapy due to AEs. In conclusion, R-CHOP-14 showed higher 2-y PFS and less toxicity compared with R-CHOP-14/CHASER in patients with high-risk DLBCL, suggesting the former to be a more promising induction regimen for further investigations (UMIN-CTR, UMIN000003823).<br /> (© 2020 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.)

Details

Language :
English
ISSN :
1349-7006
Volume :
111
Issue :
10
Database :
MEDLINE
Journal :
Cancer science
Publication Type :
Academic Journal
Accession number :
32767806
Full Text :
https://doi.org/10.1111/cas.14604