%0 Journal Article
%A Martín, Alejandro
%A Conde, Eulogio
%A Arnan, Montserrat
%A Canales, Miguel A
%A Deben, Guillermo
%A Sancho, Juan M
%A Andreu, Rafael
%A Salar, Antonio
%A García-Sanchez, Pedro
%A Vázquez, Lourdes
%A Nistal, Sara
%A Requena, María-José
%A Donato, Eva M
%A González, José A
%A León, Angel
%A Ruiz, Concepción
%A Grande, Carlos
%A González-Barca, Eva
%A Caballero, María-Dolores
%T R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study.
%D 2008
%@ 0390-6078
%U http://hdl.handle.net/10668/1286
%X BACKGROUNDThe role of re-treatment with rituximab in aggressive B-cell lymphomas still needs to be defined. This study evaluated the influence of prior exposure to rituximab on response rates and survival in patients with diffuse large B-cell lymphoma treated with rituximab plus etoposide, cytarabine, cisplatinum and methylprednisolone (R-ESHAP).DESIGN AND METHODSWe retrospectively analyzed 163 patients with relapsed or refractory diffuse large B-cell lymphoma who received R-ESHAP as salvage therapy with a curative purpose. Patients were divided into two groups according to whether rituximab had been administered (n=94, "R+" group) or not (n=69, "R-" group) prior to R-ESHAP.RESULTSResponse rates were significantly higher in the R- group in the univariate but not in the multivariate analysis. In the analysis restricted to the R+ group, we observed very low complete remission and overall response rates in patients with primary refractory disease (8% and 33%, respectively), as compared to those in patients who were in first partial remission (41% and 86%) or who had relapsed disease (50% and 75%) (p<0.01 in both cases). Overall, 60% and 65% of patients in the R+ and R- groups, respectively, underwent stem-cell transplantation after the salvage therapy. With a median follow-up of 29 months (range, 6-84), patients in the R+ group had significantly worse progression-free survival (17% vs. 57% at 3 years, p<0.0001) and overall survival (38% v 67% at 3 years, p=0.0005) than patients in the R- group. Prior exposure to rituximab was also an independent adverse prognostic factor for both progression-free survival (RR: 2.0; 95% CI: 1.2-3.3, p=0.008) and overall survival (RR: 2.2; 95% CI: 1.3-3.9, p=0.004).CONCLUSIONSR-ESHAP was associated with a high response rate in patients who were not refractory to upfront rituximab-based chemotherapy. However, the survival outcome was poor for patients previously exposed to rituximab, as compared to in those who had not previously been treated with rituximab.
%K R-ESHAP
%K Diffuse large B-Cell lymphoma
%K Rituximab
%K Salvage therapy
%K Protocolos de quimioterapia antineoplásica combinada
%K Tratamiento de última línea
%K Linfoma de células B grandes difuso
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