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Radioimmunotherapy for first-line and relapse treatment of aggressive B-cell non-Hodgkin lymphoma: an analysis of 215 patients registered in the international RIT-Network

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Very few reliable clinical data about the use of radioimmunotherapy in aggressive B-cell lymphoma exist.

Methods

Patients with aggressive B-cell lymphoma registered in the international RIT-Network were analysed with regard to prior treatment, response and side effects. The RIT-Network is a web-based registry that collects observational data from radioimmunotherapy-treated patients with malignant lymphoma across 13 countries.

Results

This analysis included 215 with aggressive B-cell lymphoma out of 232 patients registered in the RIT-Network. Histological subtypes were as follows: 190 diffuse large B-cell, 15 primary mediastinal, 9 anaplastic large cell, and 1 intravascular lymphoma. The median age of the patients was 62 years (range 17 –  88), with 27 % above the age of 70 years. Radioimmunotherapy was mainly used as consolidation after first-line or second-line chemotherapy (56.1 %), as part of third-line to eighth-line therapy for relapse (16.4 %), and in refractory disease (12.2 %). Grade IV neutropenia and thrombopenia and grade III anaemia were observed. The median time to recovery of blood count was 81 days (range 0 – 600 days). The overall response rate was 63.3 %. The complete response rate was 76.4 % in patients treated as part of first-line therapy, and 44.3 % in patients with relapse. Mean overall survival in first-line therapy patients was 32.7 months and 14.0 months in patients with relapse or refractory disease, respectively.

Conclusion

Most patients with aggressive B-cell lymphoma in the RIT-Network received radioimmunotherapy as consolidation after first-line therapy with excellent complete remission and overall survival rates compared to published data. In relapsed aggressive B-cell lymphoma, radioimmunotherapy is a safe and feasible treatment leading to satisfactory response rates with acceptable toxicity.

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References

  1. Ziepert M, Hasenclever D, Kuhnt E, Glass B, Schmitz N, Pfreundschuh M, et al. Standard International prognostic index remains a valid predictor of outcome for patients with aggressive CD20+ B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28:2373–80. doi:10.1200/JCO.2009.26.2493.

    Article  CAS  PubMed  Google Scholar 

  2. Feugier P, Van HA, Sebban C, Solal-Celigny P, Bouabdallah R, Ferme C, et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol. 2005;23:4117–26. doi:10.1200/JCO.2005.09.131.

    Article  CAS  PubMed  Google Scholar 

  3. Pfreundschuh M, Trumper L, Kloess M, Schmits R, Feller AC, Rube C, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104:634–41. doi:10.1182/blood-2003-06-2095.

    Article  CAS  PubMed  Google Scholar 

  4. Pfreundschuh M, Schubert J, Ziepert M, Schmits R, Mohren M, Lengfelder E, et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol. 2008;9:105–16. doi:10.1016/S1470-2045(08)70002-0.

    Article  CAS  PubMed  Google Scholar 

  5. Gisselbrecht C, Glass B, Mounier N, Singh GD, Linch DC, Trneny M, et al. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28:4184–90. doi:10.1200/JCO.2010.28.1618.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Witzig TE, Gordon LI, Cabanillas F, Czuczman MS, Emmanouilides C, Joyce R, et al. Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin’s lymphoma. J Clin Oncol. 2002;20:2453–63.

    Article  CAS  PubMed  Google Scholar 

  7. Witzig TE, Molina A, Gordon LI, Emmanouilides C, Schilder RJ, Flinn IW, et al. Long-term responses in patients with recurring or refractory B-cell non-Hodgkin lymphoma treated with yttrium 90 ibritumomab tiuxetan. Cancer. 2007;109:1804–10. doi:10.1002/cncr.22617.

    Article  CAS  PubMed  Google Scholar 

  8. Witzig TE, Fishkin P, Gordon LI, Gregory SA, Jacobs S, Macklis R, et al. Treatment recommendations for radioimmunotherapy in follicular lymphoma: a consensus conference report. Leuk Lymphoma. 2011;52:1188–99. doi:10.3109/10428194.2011.570396.

    Article  PubMed  Google Scholar 

  9. Zinzani PL, Gandolfi L, Stefoni V, Fanti S, Fina M, Pellegrini C, et al. Yttrium-90 ibritumomab tiuxetan as a single agent in patients with pretreated B-cell lymphoma: evaluation of the long-term outcome. Clin Lymphoma Myeloma Leuk. 2010;10:258–61. doi:10.3816/CLML.2010.n.054.

    Article  CAS  PubMed  Google Scholar 

  10. Hamlin PA, Moskowitz CH, Wegner B, Noy A, Gerecitano J, Palomba ML, et al. Sequential RCHOP and yttrium-90 ibritumomab tiuxetan (RIT) is a highly effective regimen for high risk elderly patients with untreated DLBCL. Ann Oncol. 2008;19 Suppl 4:iv100. Abstract 054.

    Google Scholar 

  11. Zinzani PL, Tani M, Fanti S, Stefoni V, Musuraca G, Castellucci P, et al. A phase II trial of CHOP chemotherapy followed by yttrium 90 ibritumomab tiuxetan (Zevalin) for previously untreated elderly diffuse large B-cell lymphoma patients. Ann Oncol. 2008;19:769–73. doi:10.1093/annonc/mdm560.

    Article  CAS  PubMed  Google Scholar 

  12. Zinzani PL, Rossi G, Franceschetti S, Botto B, Di RA, Cabras MG, et al. Phase II trial of short-course R-CHOP followed by 90Y-ibritumomab tiuxetan in previously untreated high-risk elderly diffuse large B-cell lymphoma patients. Clin Cancer Res. 2010;16:3998–4004. doi:10.1158/1078-0432.CCR-10-0162.

    Article  CAS  PubMed  Google Scholar 

  13. Yang DH, Kim WS, Kim SJ, Kim JS, Kwak JY, Chung JS, et al. Pilot trial of yttrium-90 ibritumomab tiuxetan consolidation following rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy in patients with limited-stage, bulky diffuse large B-cell lymphoma. Leuk Lymphoma. 2012;53:807–11. doi:10.3109/10428194.2011.635857.

    Article  CAS  PubMed  Google Scholar 

  14. Morschhauser F, Illidge T, Huglo D, Martinelli G, Paganelli G, Zinzani PL, et al. Efficacy and safety of yttrium-90 ibritumomab tiuxetan in patients with relapsed or refractory diffuse large B-cell lymphoma not appropriate for autologous stem-cell transplantation. Blood. 2007;110:54–8. doi:10.1182/blood-2007-01-068056.

    Article  CAS  PubMed  Google Scholar 

  15. Jaffe E, Harris N, Stein H, Vardiman JW. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. WHO Classification of Tumours. Lyon: IARC; 2008.

  16. Pfreundschuh M, Kuhnt E, Trumper L, Osterborg A, Trneny M, Shepherd L, et al. CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group. Lancet Oncol. 2011;12:1013–22. doi:10.1016/S1470-2045(11)70235-2.

    Article  CAS  PubMed  Google Scholar 

  17. Borgerding A, Hasenkamp J, Glass B, Wulf G, Trumper L. Rituximab retherapy in patients with relapsed aggressive B cell and mantle cell lymphoma. Ann Hematol. 2010;89:283–9. doi:10.1007/s00277-009-0820-9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Hagberg H, Gisselbrecht C. Randomised phase III study of R-ICE versus R-DHAP in relapsed patients with CD20 diffuse large B-cell lymphoma (DLBCL) followed by high-dose therapy and a second randomisation to maintenance treatment with rituximab or not: an update of the CORAL study. Ann Oncol. 2006;17 Suppl 4:iv31–2. doi:10.1093/annonc/mdj996.

    Article  PubMed  Google Scholar 

  19. Martin A, Conde E, Arnan M, Canales MA, Deben G, Sancho JM, et al. R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study. Haematologica. 2008;93:1829–36. doi:10.3324/haematol.13440.

    Article  CAS  PubMed  Google Scholar 

  20. Gordon LI, Molina A, Witzig T, Emmanouilides C, Raubtischek A, Darif M, et al. Durable responses after ibritumomab tiuxetan radioimmunotherapy for CD20+ B-cell lymphoma: long-term follow-up of a phase 1/2 study. Blood. 2004;103:4429–31. doi:10.1182/blood-2003-11-3883.

    Article  CAS  PubMed  Google Scholar 

  21. El GT, Dupuis J, Belhadj K, Jais JP, Rahmouni A, Copie-Bergman C, et al. Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy. Ann Oncol. 2007;18:1363–8. doi:10.1093/annonc/mdm133.

    Article  Google Scholar 

  22. Decaudin D, Mounier N, Tilly H, Ribrag V, Ghesquieres H, Bouabdallah K, et al. (90)Y ibritumomab tiuxetan (Zevalin) combined with BEAM (Z -BEAM) conditioning regimen plus autologous stem cell transplantation in relapsed or refractory low-grade CD20-positive B-cell lymphoma. A GELA phase II prospective study. Clin Lymphoma Myeloma Leuk. 2011;11:212–8. doi:10.1016/j.clml.2011.03.007.

    Article  CAS  PubMed  Google Scholar 

  23. Shimoni A, Avivi I, Rowe JM, Yeshurun M, Levi I, Or R, et al. A randomized study comparing yttrium-90 ibritumomab tiuxetan (Zevalin) and high-dose BEAM chemotherapy versus BEAM alone as the conditioning regimen before autologous stem cell transplantation in patients with aggressive lymphoma. Cancer. 2012;118:4706–14. doi:10.1002/cncr.27418.

    Article  CAS  PubMed  Google Scholar 

  24. Illidge TM. Radioimmunotherapy of lymphoma: a treatment approach ahead of its time or past its sell-by date? J Clin Oncol. 2010;28:2944–6. doi:10.1200/JCO.2009.26.8748.

    Article  PubMed  Google Scholar 

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Authorship and disclosures

The authors declare no conflicts of interest

Karin Hohloch: Analysis of the data, preparation of the manuscript

Disclosures: Advisory board: Spectrum, Roche

Henrike Lankheit: Analysis of the data

Disclosures: No disclosures

Pier Luigi Zinzani: Study design, approval of the final manuscript

Disclosures: Consultant: Millennium Takeda,

Advisory board: Celgene, Gilead, Pfizer, Millennium Takeda, Spectrum

Speaker’s bureau: Janssen, Millennium Takeda, Celgene

Honoraria: Celgene, Millennium Takeda, Pfizer, Mundipharma

Christian Scholz: Manuscript preparation, approval of the final manuscript

Advisory board: Spectrum

Speaker’s bureau: Bayer Healthcare

Michael Lorsbach: CRO, data analysis and data processing

Disclosures: No disclosures

Christine Windemuth-Kieselbach: CRO, data analysis and data processing

Disclosures: No disclosures

Lorenz Trümper Study design, approval of the final manuscript

Disclosures: Advisory board: Celgene, Roche, Pfizer, Millennium, Spectrum

Funding

The RIT-NT was supported by Bayer Healthcare

Author information

Authors and Affiliations

  1. Hematology and Oncology, Georg August University, Robert Koch Str. 40, 37075, Göttingen, Germany

    Karin Hohloch, H. K. Lankeit & L. Trümper

  2. Institute of Hematology and Medical Oncology “L. e A. Seràgnoli”, University of Bologna, 40138, Bologna, Italy

    P. L. Zinzani

  3. Hematology, Oncology and Tumor Immunology, Charité, University Berlin, 12200, Berlin, Germany

    C. W. Scholz

  4. Alcedis GmbH, Giessen, Germany

    M. Lorsbach & C. Windemuth-Kieselbach

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  1. Karin Hohloch
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  2. H. K. Lankeit
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Correspondence to Karin Hohloch.

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Hohloch, K., Lankeit, H.K., Zinzani, P.L. et al. Radioimmunotherapy for first-line and relapse treatment of aggressive B-cell non-Hodgkin lymphoma: an analysis of 215 patients registered in the international RIT-Network. Eur J Nucl Med Mol Imaging 41, 1585–1592 (2014). https://doi.org/10.1007/s00259-014-2758-y

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  • DOI: https://doi.org/10.1007/s00259-014-2758-y

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