Salvage therapy for relapsed or refractory diffuse large B-cell lymphoma: impact of prior rituximab.


most common non-Hodgkin’s lymphoma in the developed world. Anthracycline based combination chemotherapy regimens became standard of care in the 1970s after a series of studies showed longterm disease free survival with this approach. It was the pivotal study by the Group d’Etude des Lymphomas de l’Adulte (GELA), comparing CHOP versus the same regimen plus rituximab that changed practice. The use of rituximab, a monoclonal antibody targeting CD20 along with combination chemotherapy, CHOP or equivalent regimens led to complete remission (CR) rates of 75-80% and 3-5 year progression free survival (PFS) of 50-60%. Retrospective analysis of this strategy demonstrated that in adult DLBCL patients of all ages, 2-year OS increased from 52% with anthracycline based chemotherapy to 78% in the post-rituximab era. Despite this major advance, a significant proportion of patients will either experience early treatment failure, partial response or relapse after the initial chemotherapy. The initial approach to relapsed DLBCL management is to determine if the patient is a candidate for high-dose chemotherapy and autologous stem cell transplant (ASCT). In the PARMA trial, chemotherapy-sensitive relapsed DLBCL patients were randomized to salvage chemotherapy with platinum and cytarabine based regimen alone or in combination with ASCT. Both EFS and OS were significantly superior in the transplant group versus the chemotherapy alone group (46% and 53% vs. 12% and 32% respectively). Chemotherapy sensitive patients did significantly better than those who were chemotherapy-resistant (5year PFS 43% vs. 1-year survival of 22%). Based on these results, HDT/ASCT has become the standard of care in younger patients with chemosensitive relapsed or primary refractory aggressive lymphoma.

DOI: 10.3324/haematol.2008.000984

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@article{Sud2008SalvageTF, title={Salvage therapy for relapsed or refractory diffuse large B-cell lymphoma: impact of prior rituximab.}, author={Rohit Sud and Jonathan W. Friedberg}, journal={Haematologica}, year={2008}, volume={93 12}, pages={1776-80} }