TY - JOUR AU - Mark Hertzberg, AU - Maher K. Gandhi, AU - Judith Trotman, AU - Belinda Butcher, AU - John Taper, AU - Amanda Johnston, AU - Devinder Gill, AU - Shir-Jing Ho, AU - Gavin Cull, AU - Keith Fay, AU - Geoff Chong, AU - Andrew Grigg, AU - Ian D. Lewis, AU - Sam Milliken, AU - William Renwick, AU - Uwe Hahn, AU - Robin Filshie, AU - George Kannourakis, AU - Anne-Marie Watson, AU - Pauline Warburton, AU - Andrew Wirth, AU - John F. Seymour, AU - Michael S. Hofman, AU - Rodney J. Hicks, PY - 2017/01/31 Y2 - 2024/03/29 TI - Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14 JF - Haematologica JA - haematol VL - 102 IS - 2 SE - Articles DO - 10.3324/haematol.2016.154039 UR - https://haematologica.org/article/view/7975 SP - 356-363 AB - In the treatment of diffuse large B-cell lymphoma, a persistently positive [18F]fluorodeoxyglucose positron emission tomography (PET) scan typically carries a poor prognosis. In this prospective multi-center phase II study, we sought to establish whether treatment intensification with R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) chemotherapy followed by 90Y-ibritumomab tiuxetan–BEAM (BCNU, etoposide, cytarabine, and melphalan) for high-risk diffuse large B-cell lymphoma patients who are positive on interim PET scan after 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, and prednisone) can improve 2-year progression-free survival from a historically unfavorable rate of 40% to a rate of 65%. Patients received 4 cycles of R-CHOP-14, followed by a centrally-reviewed PET performed at day 17–20 of cycle 4 and assessed according to International Harmonisation Project criteria. Median age of the 151 evaluable patients was 57 years, with 79% stages 3–4, 54% bulk, and 54% International Prognostic Index 3–5. Among the 143 patients undergoing interim PET, 101 (71%) were PET-negative (96 of whom completed R-CHOP), 42 (29%) were PET-positive (32 of whom completed R-ICE and 90Y-ibritumomab tiuxetan-BEAM). At a median follow up of 35 months, the 2-year progression-free survival for PET-positive patients was 67%, a rate similar to that for PET-negative patients treated with R-CHOP-14 (74%, P=0.11); overall survival was 78% and 88% (P=0.11), respectively. In an exploratory analysis, progression-free and overall survival were markedly superior for PET-positive Deauville score 4 versus score 5 (P=0.0002 and P=0.001, respectively). Therefore, diffuse large B-cell lymphoma patients who are PET-positive after 4 cycles of R-CHOP-14 and who switched to R-ICE and 90Y-ibritumomab tiuxetan-BEAM achieved favorable survival outcomes similar to those for PET-negative R-CHOP-14-treated patients. Further studies are warranted to confirm these promising results. (Registered at: ACTRN12609001077257). ER -