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Abstract
Purpose: We evaluated the effect on long-term survival of adding rituximab (R) to BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning with or without yttrium-90 ibritumomab tiuxetan (90YIT) in patients with relapsed diffuse large B-cell lymphoma (DLBCL) undergoing autologous stem cell transplant (ASCT).Experimental design: Patients were enrolled on three consecutive phase II clinical trials. Patients received two doses of rituximab (375 and 1,000 mg/m2) during mobilization of stem cells, followed by 1,000 mg/m2 on days +1 and +8 after ASCT with R-BEAM or 90YIT-R-BEAM (90YIT dose of 0.4 mCi/kg) conditioning.Results: One hundred thirteen patients were enrolled, with 73 receiving R-BEAM and 40 receiving 90YIT-R-BEAM. All patients had a prior exposure to rituximab. The median follow-up intervals for survivors were 11.8, 8.1, and 4.2 years in the three trials, respectively. The 5-year disease-free survival (DFS) rates were 62% for R-BEAM and 65% for 90YIT-R-BEAM (P = 0.82). The 5-year overall survival rates were 73% and 77%, respectively (P = 0.65). In patients with de novo DLBCL, survival outcomes of the germinal center/activated b-cell histologic subtypes were similar with 5-year OS rates (P = 0.52) and DFS rates (P = 0.64), irrespective of their time of relapse (<1 vs. >1 year) after initial induction chemotherapy (P = 0.97).Conclusions: Administering ASCT with rituximab during stem cell collection and immediately after transplantation induces long-term disease remission and abolishes the negative prognostic impact of cell-of-origin in patients with relapsed DLBCL. The addition of 90YIT does not confer a further survival benefit.

Author information

Chahoud J1, Sui D2, Erwin WD3, Gulbis AM4, Korbling M5, Zhang M6, Ahmed S5, Alatrash G5, Anderlini P5, Ciurea SO5, Oran B5, Fayad LE7, Bassett RL Jr2, Jabbour EJ8, Medeiros LJ6, Macapinlac HA9, Young KH6, Khouri IF10.
1
Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
2
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
3
Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
4
Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
6
Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
7
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
8
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
9
Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
10
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas. ikhouri@mdanderson.org.