1. The addition of lenalidomide to standard R-CHOP chemotherapy reduced the negative prognostic impact of non-GCB phenotype in diffuse large B-cell lymphoma (DLBCL) progression-free and overall survival.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Therapy for diffuse large B-cell lymphoma (DLBCL) has advanced in recent years with the introduction of dose-intensified cytotoxic therapies as well as rituximab. There are two major subtypes of DLBCL: germinal center B-cell-like (GCB) and activated B-cell-like (ABC) or non-germinal center B-cell (non-GCB). Patients with the latter genotype have significantly worse outcomes on the standard chemotherapy combination of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone (R-CHOP) therapy. The purpose of this study was to further evaluate the effect of adding lenalidomide to R-CHOP (R2CHOP) on survival outcomes in DLBCL. At the conclusion of this phase II clinical trial, the authors found that 24 month progression-free and overall survival did not differ significantly between GCB and non-GCB patients on R2CHOP., indicating a potential benefit of lenalidomide. The results of this trial demonstrate the potential a benefit of R2CHOP in the non-GCB phenotype; however, the trial had a small sample size of patients and additional clinical trials are recommended to validate these results.
In-Depth [open-labeled clinical trial]: This phase II clinical trial included 64 patients with diffuse large B-cell lymphoma (DLBCL). Patients received lenalidomide daily for the first 10 days of standard dose R-CHOP for six cycles. Tumor immunohistochemistry was used to determined DLBCL molecular subtype to classify germinal center B-cell (GCB) versus non-GCB. The study authors selected 87 control patients with DLBCL treated with conventional R-CHOP alone from the Mayo Clinic Lymphoma Database. Overall, 98% of patients on R2CHOP achieved complete response to treatment. Event-free and overall survival at 2 years was 59% (95% CI: 48-74%) and 78% (95% CI: 68-90%), respectively. In R-CHOP only patients, progression-free and overall survival were 28% versus 64% (p < 0.001) and 46% versus 78% (p <0.001) in non-GCB versus GCB DLBCL. In R2CHOP patients, there was no difference in 2 year PFS or OS (p = 0.83 and p = 0.61) based on GCB status.
More from this author: Rituximab linked with reduced chronic immune disease following stem cell transplantation, High-dose prophylaxis for hemophilia increases costs with minimal benefit, Ambrisentan found ineffective against idiopathic pulmonary fibrosis
©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT.