Outcomes of rituximab-BEAM versus BEAM conditioning regimen in patients with diffuse large B cell lymphoma undergoing autologous transplantation. Journal Article


Authors: Jagadeesh, D; Majhail, NS; He, Y; Ahn, KW; Litovich, C; Ahmed, S; Aljurf, M; Bacher, U; Badawy, SM; Bejanyan, N; Cairo, M; Cerny, J; Epperla, N; Farhadfar, N; Freytes, CO; Gale, RP; Haverkos, B; Hossain, N; Inwards, D; Kamble, RT; Kenkre, VP; Lazarus, HM; Lazaryan, A; Lekakis, L; Mei, M; Murthy, HS; Mussetti, A; Nathan, S; Nishihori, T; Olsson, RF; Ramakrishnan Geethakumari, P; Savani, BN; Yared, JA; Fenske, TS; Kharfan-Dabaja, MA; Sureda, A; Hamadani, M
Article Title: Outcomes of rituximab-BEAM versus BEAM conditioning regimen in patients with diffuse large B cell lymphoma undergoing autologous transplantation.
Abstract: BACKGROUND: Although rituximab-based high-dose therapy is frequently used in diffuse large B cell lymphoma (DLBCL) patients undergoing autologous hematopoietic cell transplantation (auto-HCT), data supporting the benefits are not available. Herein, we report the impact of rituximab-based conditioning on auto-HCT outcomes in patients who have DLBCL. METHODS: Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, 862 adult DLBCL patients undergoing auto-HCT between 2003 and 2017 using BEAM (BCNU, etoposide, cytarabine, melphalan) conditioning regimen were included. All patients received frontline rituximab-containing chemoimmunotherapy and had chemosensitive disease pre-HCT. Early chemoimmunotherapy failure was defined as not achieving complete remission (CR) after frontline chemoimmunotherapy or relapse within 1 year of initial diagnosis. The primary outcome was overall survival (OS). RESULTS: The study cohort was divided into 2 groups: BEAM (n = 667) and R-BEAM (n = 195). On multivariate analysis, no significant difference was seen in OS (P = .83) or progression-free survival (PFS) (P = .61) across the 2 cohorts. No significant association between the use of rituximab and risk of relapse (P = .15) or nonrelapse mortality (P = .12) was observed. Variables independently associated with lower OS included older age at auto-HCT (P  .001), absence of CR at auto-HCT (P  .001) and early chemoimmunotherapy failure (P  .001). Older age (P  .0002) and non-CR pre-HCT (P  .0001) were also associated with inferior PFS. There was no significant difference in early infectious complications between the 2 cohorts. CONCLUSION: In this large registry analysis of DLBCL patients undergoing auto-HCT, the addition of rituximab to the BEAM conditioning regimen had no impact on transplantation outcomes. Older age, absence of CR pre auto-HCT, and early chemoimmunotherapy failure were associated with inferior survival.
Journal Title: Cancer
ISSN: 1097-0142; 0008-543X
Publisher: American Cancer Society  
Date Published: 2020