Which treatment for high-risk patients with DLBCL?
Mené sur 136 patients atteints d'un lymphome à cellules B à haut risque, cet essai de phase III compare, du point de vue de la survie sans événement, deux protocoles de chimiothérapie, CHOEP-14 et MegaCHOEP, en combinaison avec le rituximab avant une greffe autologue de cellules souches
he combination of the CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen with rituximab (R-CHOP) has greatly changed the outcome of patients with diffuse large B-cell lymphoma (DLBCL), with more than half of these patients now being cured. The exact proportion of those cured depends on the number of adverse prognostic factors present at diagnosis.1 However, despite improvements in outcome, some patients benefit less with the addition of rituximab. These patients include elderly patients with concomitant diseases at the time of DLBCL diagnosis (because these concomitant diseases increase the risk of toxic effects of this standard regimen) and young patients with aggressive characteristics (for whom standard R-CHOP does not result in a high complete-response rate and low relapse rate). A high score on the age-adjusted International Prognostic Index is usually an indicator of poor prognosis but its discriminatory power is poor. Good prognostic indicators have not yet been described but the presence of MYC rearrangement and BCL2 rearrangement (double-hit DLBCL) is certainly a good approach.2 The 5-year survival of patients with MYC rearrangement is significantly worse (around 30%) than those without MYC rearrangement (usually over 70%). Patients with concurrent MYC and BCL2 rearrangements often have features intermediate between DLBCL and Burkitt's lymphoma and have inferior survival. Patients with hyperexpression of the MYC protein represent 15—30% of all patients with DLBCL. While MYC and BCL2 rearrangements are usually present in germinal centre DLBCL, MYC and BCL2 hyperexpression are present in both germinal centre and activated B-cell DLBCL...
The Lancet Oncology , commentaire en libre accès, 2011