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Prepublished online as a Blood First Edition Paper on February 6, 2003; DOI 10.1182/blood-2002-11-3442.

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Blood, 1 June 2003, Vol. 101, No. 11, pp. 4279-4284

CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

Rituximab plus CHOP (R-CHOP) overcomes bcl-2—associated resistance to chemotherapy in elderly patients with diffuse large B-cell lymphoma (DLBCL)

Nicolas Mounier, Josette Briere, Christian Gisselbrecht, Jean-Francois Emile, Pierre Lederlin, Catherine Sebban, Francoise Berger, Andre Bosly, Pierre Morel, Herve Tilly, Reda Bouabdallah, Felix Reyes, Philippe Gaulard, and Bertrand Coiffier

From the Service d'Onco-Hématologie, INSERM ERM0220-Hôpital Saint Louis, AP-HP, Paris, France; Service d'Anatomie Pathologique, Hôpital Paul Brousse, AP-HP, Villejuif, France; Service de Médecine A, Hôpital Brasbois, Vandoeuvre les Nancy, France; Service d'Hématologie, Centre Léon Bérard, Pierre Bénite, France; Service d'Anatomie Pathologique, Centre Hospitalier Lyon Sud, Pierre Bénite, France; Service d'Hématologie, Cliniques Universitaires de Mont Godine, Yvoir, Belgium; Service d'Hématologie, Hôpital du Docteur Schaffner, Lens, France; Service d'Hématologie, Centre Henri Becquerel, Rouen, France; Service d'Hématologie, Institut Paoli Calmette, Marseille, France; Service d'Hématologie, Hôpital Henri Mondor, AP-HP, Créteil, France; Département de Pathologie, EA2348-Hôpital Henri Mondor, AP-HP, Créteil, France; and Service d'Hématologie, Centre Hospitalier Lyon Sud, Lyon, France, for the Groupe d'Etude des Lymphomes de l'Adulte (GELA).

In diffuse large B-cell lymphoma (DLBCL), the combination of rituximab and CHOP (cyclophosphamide, doxorubicine, vincristine, prednisone; R-CHOP) has been shown to be more effective than CHOP for the treatment of elderly patients. Bcl-2 protein expression has been associated with poor prognosis in patients with DLBCL. To establish whether or not rituximab reduces bcl-2—associated treatment failure, we studied bcl-2 protein expression and clinical outcome in patients included in the Groupe d'Etude des Lymphomes de l'Adulte LNH-98-5 trial. Patients between 60 and 80 years of age were randomized to receive 8 cycles of either CHOP or R-CHOP every 3 weeks. Of the 399 patients included, 292 with histologically proven DLBCL had material available for bcl-2 study. Tumors were considered positive when at least 50% of tumor cells expressed bcl-2 protein. There were 193 (66%) bcl-2+ patients and 99 (34%) bcl-2 patients. The response rates for R-CHOP and CHOP were, respectively, 78% and 60% (P = .01) in bcl-2+ patients and 76% and 73% (P = .7) in bcl-2 patients. At a median of 2 years of follow-up, R-CHOP was significantly associated with a better overall survival than CHOP in bcl-2+ patients (67% ± 9% versus 48% ± 11%, P = .004). In bcl-2 patients there was no statistically significant difference (72% ± 12% versus 67% ± 14%, P = .6). In addition, R-CHOP was associated with significantly better event-free survival than CHOP in bcl-2+ patients (58% ± 10% versus 32% ± 10%, P < .001) but not in bcl-2 patients (60% ± 13% versus 40% ± 15%, P = .13). Multivariate analysis confirmed the significant benefit for survival and event-free survival of R-CHOP in bcl-2+ patients. These results suggest that rituximab is able to prevent chemotherapy failure in patients with bcl-2 protein overexpression.


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M. I. Vega, A. R. Jazirehi, S. Huerta-Yepez, and B. Bonavida
Rituximab-Induced Inhibition of YY1 and Bcl-xL Expression in Ramos Non-Hodgkin's Lymphoma Cell Line via Inhibition of NF-{kappa}B Activity: Role of YY1 and Bcl-xL in Fas Resistance and Chemoresistance, Respectively
J. Immunol., August 15, 2005; 175(4): 2174 - 2183.
[Abstract] [Full Text] [PDF]


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BloodHome page
J. S. Abramson and M. A. Shipp
Advances in the biology and therapy of diffuse large B-cell lymphoma: moving toward a molecularly targeted approach
Blood, August 15, 2005; 106(4): 1164 - 1174.
[Abstract] [Full Text] [PDF]


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BloodHome page
J. C. Reed and M. Pellecchia
Apoptosis-based therapies for hematologic malignancies
Blood, July 15, 2005; 106(2): 408 - 418.
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BloodHome page
Y. Natkunam, I. S. Lossos, B. Taidi, S. Zhao, X. Lu, F. Ding, A. S. Hammer, T. Marafioti, G. E. Byrne Jr, S. Levy, et al.
Expression of the human germinal center-associated lymphoma (HGAL) protein, a new marker of germinal center B-cell derivation
Blood, May 15, 2005; 105(10): 3979 - 3986.
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JCOHome page
S. J. Horning
In Reply:
J. Clin. Oncol., May 1, 2005; 23(13): 3162 - 3163.
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JRSMHome page
A. P Levene, G. Singh, and C. Palmieri
Therapeutic monoclonal antibodies in oncology
J R Soc Med, April 1, 2005; 98(4): 146 - 152.
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JCOHome page
I. F. Khouri, R. M. Saliba, C. Hosing, G.-J. Okoroji, S. Acholonu, P. Anderlini, D. Couriel, M. De Lima, M. L. Donato, L. Fayad, et al.
Concurrent Administration of High-Dose Rituximab Before and After Autologous Stem-Cell Transplantation for Relapsed Aggressive B-Cell Non-Hodgkin's Lymphomas
J. Clin. Oncol., April 1, 2005; 23(10): 2240 - 2247.
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BloodHome page
J. J. F. Muris, S. A. G. M. Cillessen, W. Vos, I. S. van Houdt, J. A. Kummer, J. H. J. M. van Krieken, N. M. Jiwa, P. M. Jansen, H. C. Kluin-Nelemans, G. J. Ossenkoppele, et al.
Immunohistochemical profiling of caspase signaling pathways predicts clinical response to chemotherapy in primary nodal diffuse large B-cell lymphomas
Blood, April 1, 2005; 105(7): 2916 - 2923.
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NEJMHome page
J. O. Armitage
Defining the Stages of Aggressive Non-Hodgkin's Lymphoma -- A Work in Progress
N. Engl. J. Med., March 24, 2005; 352(12): 1250 - 1252.
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ASH Education BookHome page
J. W. Sweetenham
Diffuse Large B-Cell Lymphoma: Risk Stratification and Management of Relapsed Disease
Hematology, January 1, 2005; 2005(1): 252 - 259.
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ASH ANNUAL MEETING ABSTRACTSHome page
E. Paszkiewicz-Kozik, O. Mioduszewska, I. Federowicz, E. Kraszewska, E. Kulczycka, K. Domanska-Czyz, B. Ostrowska, J. Romejko-Jarosinska, M. Osowiecki, and J. A. Walewski
Predictive Value of Bcl-2 and Bcl-6 Protein Expression in Diffuse Large B-Cell Lymphoma Patients from a Single Institution.
Blood (ASH Annual Meeting Abstracts), November 16, 2004; 104(11): 4546 - 4546.
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BloodHome page
G. Cartron, H. Watier, J. Golay, and P. Solal-Celigny
From the bench to the bedside: ways to improve rituximab efficacy
Blood, November 1, 2004; 104(9): 2635 - 2642.
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CA Cancer J ClinHome page
B. D. Cheson
What Is New in Lymphoma?
CA Cancer J Clin, September 1, 2004; 54(5): 260 - 272.
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BloodHome page
B. Coiffier, G. Salles, M. Pfreundschuh, and M. Loeffler
Immunochemotherapy is the standard of care in elderly patients with diffuse large B-cell lymphoma
Blood, September 1, 2004; 104(5): 1584 - 1586.
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Clin. Cancer Res.Home page
J. W. Friedberg
Developing New Monoclonal Antibodies for Aggressive Lymphoma: A Challenging Road in the Rituximab Era
Clin. Cancer Res., August 15, 2004; 10(16): 5297 - 5298.
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Rheumatology (Oxford)Home page
M. Voulgarelis, S. Giannouli, D. Anagnostou, and A. G. Tzioufas
Combined therapy with rituximab plus cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP) for Sjogren's syndrome-associated B-cell aggressive non-Hodgkin's lymphomas
Rheumatology, August 1, 2004; 43(8): 1050 - 1053.
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BloodHome page
M. Ghielmini, S.-F. H. Schmitz, S. B. Cogliatti, G. Pichert, J. Hummerjohann, U. Waltzer, M. F. Fey, D. C. Betticher, G. Martinelli, F. Peccatori, et al.
Prolonged treatment with rituximab in patients with follicular lymphoma significantly increases event-free survival and response duration compared with the standard weekly x 4 schedule
Blood, June 15, 2004; 103(12): 4416 - 4423.
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BloodHome page
F. Grange, T. Petrella, M. Beylot-Barry, P. Joly, M. D'Incan, M. Delaunay, L. Machet, M.-F. Avril, S. Dalac, P. Bernard, et al.
Bcl-2 protein expression is the strongest independent prognostic factor of survival in primary cutaneous large B-cell lymphomas
Blood, May 15, 2004; 103(10): 3662 - 3668.
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JCOHome page
J. A. Sparano, S. Lee, M. G. Chen, T. Nazeer, A. Einzig, R. F. Ambinder, D. H. Henry, J. Manalo, T. Li, and J. H. Von Roenn
Phase II Trial of Infusional Cyclophosphamide, Doxorubicin, and Etoposide in Patients With HIV-Associated Non-Hodgkin's Lymphoma: An Eastern Cooperative Oncology Group Trial (E1494)
J. Clin. Oncol., April 15, 2004; 22(8): 1491 - 1500.
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BloodHome page
T. Decker, M. Oelsner, R. J. Kreitman, G. Salvatore, Q.-c. Wang, I. Pastan, C. Peschel, and T. Licht
Induction of caspase-dependent programmed cell death in B-cell chronic lymphocytic leukemia by anti-CD22 immunotoxins
Blood, April 1, 2004; 103(7): 2718 - 2726.
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ASH Education BookHome page
P. A. Volberding, K. R. Baker, and A. M. Levine
Human Immunodeficiency Virus Hematology
Hematology, January 1, 2003; 2003(1): 294 - 313.
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