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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-2associated 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-2associated 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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K. Leroy, J.-P. Jais, C. Haioun, D. Rickman, A. de Reynies, T. Molina, B. Coiffier, F. Berger, C. Gisselbrecht, J. Briere, et al.
Gene Expression Profile Associated with Survival in Patients with Diffuse Large B-Cell Lymphoma Treated by Chemotherapy and Rituximab.
Blood (ASH Annual Meeting Abstracts),
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[Abstract]
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L. D. Kaplan, J. Y. Lee, R. F. Ambinder, J. A. Sparano, E. Cesarman, A. Chadburn, A. M. Levine, and D. T. Scadden
Rituximab does not improve clinical outcome in a randomized phase 3 trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin lymphoma: AIDS-Malignancies Consortium Trial 010
Blood,
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1538 - 1543.
[Abstract]
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C. Hoffmann, M. Tiemann, C. Schrader, D. Janssen, E. Wolf, M. Vierbuchen, R. Parwaresch, K. Ernestus, A. Plettenberg, A. Stoehr, et al.
AIDS-related B-cell lymphoma (ARL): correlation of prognosis with differentiation profiles assessed by immunophenotyping
Blood,
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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.,
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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;
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[Abstract]
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J. C. Reed and M. Pellecchia
Apoptosis-based therapies for hematologic malignancies
Blood,
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106(2):
408 - 418.
[Abstract]
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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,
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[Abstract]
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S. J. Horning
In Reply:
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A. P Levene, G. Singh, and C. Palmieri
Therapeutic monoclonal antibodies in oncology
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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
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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,
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J. O. Armitage
Defining the Stages of Aggressive Non-Hodgkin's Lymphoma -- A Work in Progress
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J. W. Sweetenham
Diffuse Large B-Cell Lymphoma: Risk Stratification and Management of Relapsed Disease
Hematology,
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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),
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G. Cartron, H. Watier, J. Golay, and P. Solal-Celigny
From the bench to the bedside: ways to improve rituximab efficacy
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B. Coiffier, G. Salles, M. Pfreundschuh, and M. Loeffler
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J. W. Friedberg
Developing New Monoclonal Antibodies for Aggressive Lymphoma: A Challenging Road in the Rituximab Era
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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,
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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,
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[Abstract]
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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,
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[Abstract]
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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)
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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
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[Abstract]
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P. A. Volberding, K. R. Baker, and A. M. Levine
Human Immunodeficiency Virus Hematology
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January 1, 2003;
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[Abstract]
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