Peripheral blood stem cell mobilization following CHOP plus rituximab therapy combined with G-CSF in patients with B-cell non-Hodgkin's lymphoma
Tomoyuki EndoNorihiro SatoYuko MogiK KoizumiMotohide NishioKatsuya FujimotoTomomi SAKAIKohki KumanoMasato ObaraHirokazu IkedaTakayoshi Koike
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Autologous stem-cell transplantation
Leukapheresis
Therapeutic effect and toxicity of CHEP and CHOP chemotherapy in the treatment of non-Hodgkin's lymphoma (NHL) were compared.From October 1989 to June 1996, comparison of 52 NHL was carried out: CHEP (cyclophol-sphamide, adriamycin, etoposide, prednisone) group-26 patients and CHOP(cyclophosphamide, adriamycin, vincristine, prednisone) group-26 patients. The responses and toxicities were compared by the chi 2 test.The CHEP group gave an overall response rate of 76.9%(20/26). In 10 untreated patients CR was observed in 7; The CHOP group gave an overall response rate of 65.4%(17/26). In 17 untreated patients CR was observed in 8(P > 0.05). Having been followed to the end of August, 1996, 16 patients in the CHEP group and 15 patients in the CHOP group were alive with respective median survivals 24(3-66) months and 20(2-48) months. Among the untreated patients, the 1-year disease-free survival (DFS) rates of those who gave CR were 70.0% and 23.5% (P < 0.05). 2-5 year DFS rats were 30%, 20%, 20%, 20%, and 11.8%, 5.9%, 5.9%, orespectively. The toxic reactions were tolerable in both groups.In untreated NHL patients as treated with CHEP chemotherapy, 1-year DFS rate was superior to that of CHOP regimen (P < 0.05). Side toxicities were comparable in both groups, but no peripheral neuritis was observed in the CHEP group.
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Patients with aggressive non-Hodgkin's lymphoma (NHL) showing several risk factors have a poor prognosis. In such patients, conventional chemotherapy results in a low complete response rate and a high relapse rate. We performed a prospective trial of intensive induction chemotherapy followed by high-dose consolidation therapy to determine the feasibility of such an approach. We treated 39 patients with aggressive poor risk NHL with double-CHOP (D-CHOP) chemotherapy followed by high-dose therapy (HDT) with or without peripheral blood stem cell transfusion (PBSCT). The median age of the patients was 54 years (range 17-65). Twenty-seven were considered to be at high (H) and 12 were at high-intermediate (H-I) risk according to the age-adjusted International Prognostic Index. Thirty-four patients (87%) responded (complete response: 74%, partial response: 13%) to D-CHOP chemotherapy. Of the 34 responders, 24 received HDT followed by PBSCT, 7 received high-dose methotrexate, and 3 refused consolidation therapy. At a median follow-up period of 26 months, the estimated 3-year overall survival rate and event-free survival rate was 64 and 51%, respectively. Our data suggest that dose-intensified D-CHOP followed by consolidation HDT is safe and appears efficacious in aggressive NHL patients with H-I and H risk.
International Prognostic Index
Aggressive lymphoma
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Treatment with CHOP chemotherapy in elderly patients with aggressive non-Hodgkin's lymphoma (NHL) is less effective and accompanied by more adverse effects than in younger patients. The prophylactic use of granulocyte colony-stimulating factor (G-CSF) might improve the results, but increases the costs of treatment. We analyzed the costs of therapy and follow-up of patients with NHL treated with CHOP with or without G-CSF prophylaxis.Four hundred and eleven patients were randomized for treatment with CHOP or CHOP+G-CSF. A detailed study of treatment costs from randomization until 3 years of follow-up or death was performed in a subset of 100 out of 389 eligible patients. Because costs during follow-up were independent of the use of G-CSF during treatment, costs of follow-up and second-line treatment were calculated irrespective of the treatment arm.Total hospital costs for first-line treatment were 12178 [95% CI 10297 - 14059] for CHOP alone and 18356 [95% CI 15807 - 20906] for CHOP + G-CSF. Costs during follow-up showed a wide difference (range 74 - 53925) depending on disease status and choice of treatment in the case of relapse or progression.The clinical study showed no difference between the treatment arms in response, overall survival or event-free survival, while the costs were significantly higher in the G-CSF arm. We conclude that the addition of prophylactic G-CSF to CHOP chemotherapy is not cost-effective in these patients.
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Re-treatment with rituximab for B-cell non-Hodgkin's lymphoma (NHL) relapsing after previous rituximab therapy has recently been shown to be clinically efficacious. Although the mechanism of resistance to rituximab re-treatment in non-responding patients is unknown, it is possible that loss of CD20 expression in the relapsed NHL could be important in some patients. We examined the incidence and nature of CD20 negative relapses following rituximab therapy in aggressive B-cell NHL treated at our institution. Of a total of 18 patients who received rituximab, 13 have relapsed, with 10 patients subsequently undergoing repeat tissue biopsy. Six of these 10 patients (60%) were shown to have lost CD20 expression by either immunohistochemistry and/or flow cytometry. Furthermore, three of the six patients who relapsed with CD20-negative NHL also suffered relapses at unusual anatomical sites. We conclude that loss of CD20 expression in aggressive B-cell NHL relapsing post-rituximab therapy is common. As such, repeat tissue biopsy should be undertaken to document CD20 expression by both flow cytometry and immunohistochemistry prior to considering repeated courses of rituximab in relapsed aggressive lymphomas.
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Non-Hodgkin’s lymphomas (NHLs) are a heterogeneous group of different haematological cancers with a wide range of aggressiveness. NHLs represent >80% of lymphomas and the majority of NHLs involve B cells. CD20 represents a good target for NHL immunotherapy because it is largely expressed on B cell NHL and not on B cell precursors and plasma cells. The anti-CD20 monoclonal antibody (mAb) rituximab (RTX) was the first antibody approved by the FDA for lymphoma therapy and has revolutionised B cell lymphoma treatment. Several clinical trials have demonstrated the high efficacy of RTX, resulting in a significant improvement in overall response rates and in NHL patient survival. However, RTX, both as a single agent and in combination with chemotherapy, induces several side-effects and resistance mechanisms. Remarkable efforts have been made to improve RTX efficacy, including conjugation to an active moiety (radionuclide, toxin, enzyme, or drug) and the development of new anti-CD20 mAbs. This review summarises the characteristics of RTX and other anti-CD20 mAbs for NHL treatment; the results of the main clinical trials are reported.
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Aggressive lymphoma
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Objective To comprehensively evaluate the curative effect and adverse effects of rituximab plus cyclophosphamide, vincristine, doxoruhicin and prednisone(R-CHOP) chemotherapy and CHOP chemotherapy alone on the treatment for low and moderate malignant B cell non-Hodgkin lymphoma (NHL). Methods By the application of the systematic review method of Cochrance International Collaboration, the world-wide randomized controlled trials (RCT) on the comparison between different curative effects of R-CHOP and CHOP chemotherapy alone on the treatment low and moderate malignant B cell NHL was collected and the study results was evaluated systematically. Results Seven RCT studies involving 1569 and had no heterogeneity between themselves (χ=5.31,P=0.50). The baseline of patients characteristics was comparable in all the studies. By comparing complete response (CR) rate and adverse effects through fixed effect analysis model, the results showed that R-CHOP was better than CHOP chemotherapy on the treatment for low and moderate malignant B cell NHL(OR =2.22, 95 %CI 1.72-2.85, P ＜0.000 01), and adverse events of R-CHOP had no significant difference compared with CHOP chemotherapy alone (P＞0.05). Conclusion With good curative effect on the treatment low and moderate malignant B cell NHL and without obvious differences from the CHOP chemotherapy alone in adverse effects, R-CHOP chemotherapy should be recommended as the best treatment method for low and moderate malignant B cell NHL And much more well-designed clinical RCT should be made to further prove its clinical effect.
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Lymphoma, non-Hodgkin; Antineoplastic combined chemotherapy protocols; Metaanalysis; Randomized controlled trials
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Objective To study the effect of Aidi injection on quality of life for non Hodgkin's lymphoma(NHL).Methods 103 NHL patients were randomly divided into two groups.CHOP regiment group and CHOP regiment plus Aidi injection.The adverse effect and scores of quality of life(QOL) during chemotherapy were observed and recorded.Results There were significant difference in adverse effect and scores QOL during chemotherapy in two groups(P0.01).Conclusion CHOP regiment plus Aidi injection can reduce adverse effect of chemotherapy and improve QOL of NHL
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