Impact of pre-transplant rituximab on survival after autologous hematopoietic stem cell transplantation for diffuse large B cell lymphoma

Timothy S. Fenske, Parameswaran N. Hari, Jeanette Carreras, Mei Jie Zhang, Rammurti T. Kamble, Brian J. Bolwell, Mitchell S. Cairo, Richard E. Champlin, Yi Bin Chen, César O. Freytes, Robert Peter Gale, Gregory A. Hale, Osman Ilhan, H. Jean Khoury, John Lister, Dipnarine Maharaj, David I. Marks, Reinhold Munker, Andrew L. Pecora, Philip A. RowlingsThomas C. Shea, Patrick Stiff, Peter H. Wiernik, Jane N. Winter, J. Douglas Rizzo, Koen van Besien, Hillard M. Lazarus, Julie M. Vose

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Abstract

Incorporation of the anti-CD20 monoclonal antibody rituximab into front-line regimens to treat diffuse large B cell lymphoma (DLBCL) has resulted in improved survival. Despite this progress, however, many patients develop refractory or recurrent DLBCL and then undergo autologous hematopoietic stem cell transplantation (AuHCT). It is unclear to what extent pre-transplant exposure to rituximab affects outcomes after AuHCT. Outcomes of 994 patients receiving AuHCT for DLBCL between 1996 and 2003 were analyzed according to whether rituximab was (n = 176; +R cohort) or was not (n = 818; -R cohort) administered with front-line or salvage therapy beforeAuHCT. The +R cohort had superior progression-free survival (PFS; 50% vs 38%; P = .008) and overall survival (OS; 57% vs 45%; P = .006) at 3 years. Platelet and neutrophil engraftment were not affected by exposure to rituximab. Nonrelapse mortality (NRM) did not differ significantly between the 2 cohorts. In multivariate analysis, the +R cohort had improved PFS (relative risk of relapse/progression or death, 0.64; P <.001) and improved OS (relative risk of death, 0.74; P = .039). We conclude that pre-transplant rituximab is associated with a lower rate of progression and improved survival after AuHCT for DLBCL, with no evidence of impaired engraftment or increased NRM.

Original languageEnglish (US)
Pages (from-to)1455-1464
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume15
Issue number11
DOIs
StatePublished - Nov 2009

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Lymphoma, Large B-Cell, Diffuse
Hematopoietic Stem Cell Transplantation
Transplants
Survival
Salvage Therapy
Mortality
Disease-Free Survival
Neutrophils
Blood Platelets
Multivariate Analysis
Monoclonal Antibodies
Rituximab
Recurrence

Keywords

  • Autologous hematopoietic stem cell transplantation
  • Lymphoma
  • Rituximab

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Impact of pre-transplant rituximab on survival after autologous hematopoietic stem cell transplantation for diffuse large B cell lymphoma. / Fenske, Timothy S.; Hari, Parameswaran N.; Carreras, Jeanette; Zhang, Mei Jie; Kamble, Rammurti T.; Bolwell, Brian J.; Cairo, Mitchell S.; Champlin, Richard E.; Chen, Yi Bin; Freytes, César O.; Gale, Robert Peter; Hale, Gregory A.; Ilhan, Osman; Khoury, H. Jean; Lister, John; Maharaj, Dipnarine; Marks, David I.; Munker, Reinhold; Pecora, Andrew L.; Rowlings, Philip A.; Shea, Thomas C.; Stiff, Patrick; Wiernik, Peter H.; Winter, Jane N.; Rizzo, J. Douglas; van Besien, Koen; Lazarus, Hillard M.; Vose, Julie M.

In: Biology of Blood and Marrow Transplantation, Vol. 15, No. 11, 11.2009, p. 1455-1464.

Research output: Contribution to journalArticle

Fenske, TS, Hari, PN, Carreras, J, Zhang, MJ, Kamble, RT, Bolwell, BJ, Cairo, MS, Champlin, RE, Chen, YB, Freytes, CO, Gale, RP, Hale, GA, Ilhan, O, Khoury, HJ, Lister, J, Maharaj, D, Marks, DI, Munker, R, Pecora, AL, Rowlings, PA, Shea, TC, Stiff, P, Wiernik, PH, Winter, JN, Rizzo, JD, van Besien, K, Lazarus, HM & Vose, JM 2009, 'Impact of pre-transplant rituximab on survival after autologous hematopoietic stem cell transplantation for diffuse large B cell lymphoma', Biology of Blood and Marrow Transplantation, vol. 15, no. 11, pp. 1455-1464. https://doi.org/10.1016/j.bbmt.2009.07.017
Fenske, Timothy S. ; Hari, Parameswaran N. ; Carreras, Jeanette ; Zhang, Mei Jie ; Kamble, Rammurti T. ; Bolwell, Brian J. ; Cairo, Mitchell S. ; Champlin, Richard E. ; Chen, Yi Bin ; Freytes, César O. ; Gale, Robert Peter ; Hale, Gregory A. ; Ilhan, Osman ; Khoury, H. Jean ; Lister, John ; Maharaj, Dipnarine ; Marks, David I. ; Munker, Reinhold ; Pecora, Andrew L. ; Rowlings, Philip A. ; Shea, Thomas C. ; Stiff, Patrick ; Wiernik, Peter H. ; Winter, Jane N. ; Rizzo, J. Douglas ; van Besien, Koen ; Lazarus, Hillard M. ; Vose, Julie M. / Impact of pre-transplant rituximab on survival after autologous hematopoietic stem cell transplantation for diffuse large B cell lymphoma. In: Biology of Blood and Marrow Transplantation. 2009 ; Vol. 15, No. 11. pp. 1455-1464.
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AU - Fenske, Timothy S.

AU - Hari, Parameswaran N.

AU - Carreras, Jeanette

AU - Zhang, Mei Jie

AU - Kamble, Rammurti T.

AU - Bolwell, Brian J.

AU - Cairo, Mitchell S.

AU - Champlin, Richard E.

AU - Chen, Yi Bin

AU - Freytes, César O.

AU - Gale, Robert Peter

AU - Hale, Gregory A.

AU - Ilhan, Osman

AU - Khoury, H. Jean

AU - Lister, John

AU - Maharaj, Dipnarine

AU - Marks, David I.

AU - Munker, Reinhold

AU - Pecora, Andrew L.

AU - Rowlings, Philip A.

AU - Shea, Thomas C.

AU - Stiff, Patrick

AU - Wiernik, Peter H.

AU - Winter, Jane N.

AU - Rizzo, J. Douglas

AU - van Besien, Koen

AU - Lazarus, Hillard M.

AU - Vose, Julie M.

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N2 - Incorporation of the anti-CD20 monoclonal antibody rituximab into front-line regimens to treat diffuse large B cell lymphoma (DLBCL) has resulted in improved survival. Despite this progress, however, many patients develop refractory or recurrent DLBCL and then undergo autologous hematopoietic stem cell transplantation (AuHCT). It is unclear to what extent pre-transplant exposure to rituximab affects outcomes after AuHCT. Outcomes of 994 patients receiving AuHCT for DLBCL between 1996 and 2003 were analyzed according to whether rituximab was (n = 176; +R cohort) or was not (n = 818; -R cohort) administered with front-line or salvage therapy beforeAuHCT. The +R cohort had superior progression-free survival (PFS; 50% vs 38%; P = .008) and overall survival (OS; 57% vs 45%; P = .006) at 3 years. Platelet and neutrophil engraftment were not affected by exposure to rituximab. Nonrelapse mortality (NRM) did not differ significantly between the 2 cohorts. In multivariate analysis, the +R cohort had improved PFS (relative risk of relapse/progression or death, 0.64; P <.001) and improved OS (relative risk of death, 0.74; P = .039). We conclude that pre-transplant rituximab is associated with a lower rate of progression and improved survival after AuHCT for DLBCL, with no evidence of impaired engraftment or increased NRM.

AB - Incorporation of the anti-CD20 monoclonal antibody rituximab into front-line regimens to treat diffuse large B cell lymphoma (DLBCL) has resulted in improved survival. Despite this progress, however, many patients develop refractory or recurrent DLBCL and then undergo autologous hematopoietic stem cell transplantation (AuHCT). It is unclear to what extent pre-transplant exposure to rituximab affects outcomes after AuHCT. Outcomes of 994 patients receiving AuHCT for DLBCL between 1996 and 2003 were analyzed according to whether rituximab was (n = 176; +R cohort) or was not (n = 818; -R cohort) administered with front-line or salvage therapy beforeAuHCT. The +R cohort had superior progression-free survival (PFS; 50% vs 38%; P = .008) and overall survival (OS; 57% vs 45%; P = .006) at 3 years. Platelet and neutrophil engraftment were not affected by exposure to rituximab. Nonrelapse mortality (NRM) did not differ significantly between the 2 cohorts. In multivariate analysis, the +R cohort had improved PFS (relative risk of relapse/progression or death, 0.64; P <.001) and improved OS (relative risk of death, 0.74; P = .039). We conclude that pre-transplant rituximab is associated with a lower rate of progression and improved survival after AuHCT for DLBCL, with no evidence of impaired engraftment or increased NRM.

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KW - Lymphoma

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