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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Journal of Hematology & Oncology 1/2017

Rituximab-containing reduced-intensity conditioning improves progression-free survival following allogeneic transplantation in B cell non-Hodgkin lymphoma

Zeitschrift:
Journal of Hematology & Oncology > Ausgabe 1/2017
Autoren:
Narendranath Epperla, Kwang Woo Ahn, Sairah Ahmed, Madan Jagasia, Alyssa DiGilio, Steven M. Devine, Samantha Jaglowski, Vanessa Kennedy, Andrew R. Rezvani, Sonali M. Smith, Anna Sureda, Timothy S. Fenske, Mohamed A. Kharfan-Dabaja, Phillipe Armand, Mehdi Hamadani
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s13045-017-0487-y) contains supplementary material, which is available to authorized users.

Abstract

Background

In B cell non-Hodgkin lymphoma (B-NHL), rituximab-containing reduced-intensity conditioning regimens (R-RIC) have been shown to provide favorable outcomes in single-arm studies; however, large multicenter studies comparing R-RIC and non-rituximab-containing reduced-intensity conditioning regimens (nonR-RIC) have not been performed. Using the CIBMTR database, we report the outcomes of R-RIC versus nonR-RIC regimens in B-NHL.

Methods

We evaluated 1401 adult B-NHL patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who received nonR-RIC (n = 1022) or R-RIC (n = 379) regimens. Graft-versus-host disease (GVHD) prophylaxis was limited to calcineurin inhibitor-based approaches.

Results

Median follow-up of survivors in the R-RIC and nonR-RIC groups was 47 and 37 months, respectively. On multivariate analysis, no difference was seen between the R-RIC and nonR-RIC cohorts in terms of acute GVHD grade II–IV (RR = 1.14, 95%CI = 0.83–1.56, p = 0.43) or grade III–IV (RR = 1.16, 95%CI = 0.72–1.89, p = 0.54), chronic GVHD (RR = 1.15, 95%CI = 0.92–1.46, p = 0.22), non-relapse mortality (RR = 0.90; 95%CI = 0.67–1.22; p = 0.51), relapse/progression (RR = 0.79; 95%CI = 0.63–1.01; p = 0.055), and mortality (RR = 0.84, 95%CI = 0.69–1.02, p = 0.08) risk. However, R-RIC was associated with a significantly improved progression-free survival (RR = 0.76; 95%CI 0.62–0.92; p = 0.006). On subgroup analysis, mortality benefit was noted in the R-RIC group patients not receiving busulfan-based RIC (RR = 0.76; 95%CI = 0.60–0.96; p = 0.02) and with the use of a higher cumulative rituximab dose (RR = 0.43; 95%CI = 0.21–0.90; p = 0.02).

Conclusion

Our analysis shows that inclusion of rituximab in RIC regimens improves progression-free survival in patients with B cell NHL. These data supports the use of R-RIC in B-NHL patients undergoing allo-HCT.

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Zusatzmaterial
Additional file 1: Table S1. Variables tested in Cox proportional hazards regression models. Table S2. Complete multivariate analysis results. Table S3. Multivariate analysis results for follicular lymphoma. Table S4. Multivariate analysis results for mantle cell lymphoma. Table S5. Multivariate analysis results for diffuse large B cell lymphoma. Table S6. Univariate analysis—chemorefractory patients. Table S7. Causes of death. Table S8. Studies incorporating rituximab to allo-HCT conditioning regimens in B cell NHL (DOCX 81 kb)
13045_2017_487_MOESM1_ESM.docx
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