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R-CHOP 14 with or without radiotherapy in non-bulky limited-stage diffuse large B-cell lymphoma (DLBCL)

Thierry Lamy 1, 2, * Gandhi Damaj 3 Pierre Soubeyran 4 Emmanuel Gyan 5 Guillaume Cartron 6, 7 Krimo Bouabdallah 8 Rémy Gressin 9 Jérôme Cornillon 10 Anne Banos 11 Katell Le Du Mohamed Benchalal 12 Marie-Pierre Moles Steven Le Gouill 13 Joel Fleury Pascal Godmer 14 Hervé Maisonneuve 15 Eric Deconinck 16 Roch Houot 17, 2 Kamel Laribi Jean Pierre Marolleau Olivier Tournilhac 18 Bernard Branger 19 Anne Devillers 20 Philippe Vuilliez Thierry Fest 2 Philippe Colombat 21 Valérie Costes 22, 23 Vanessa Szablewski 22 Marie C. Béné 24 Vincent Delwail 25, 26
Abstract : The benefit of radiotherapy (RT) after chemotherapy in limited-stage diffuse large B-cell lymphoma (DLBCL) remains controversial. We conducted a randomized trial in patients with nonbulky limited-stage DLBCL to evaluate the benefit of RT after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Patients were stratified according to the modified International Prognostic Index, including lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, age, and disease stage. The patients received 4 or 6 consecutive cycles of R-CHOP delivered once every 2 weeks, followed or not by RT at 40 Gy delivered 4 weeks after the last R-CHOP cycle. All patients were evaluated by fluorodeoxyglucose-positron emission tomography scans performed at baseline, after 4 cycles of R-CHOP, and at the end of treatment. The primary objective of the trial was event-free survival (EFS) from randomization. The trial randomly assigned 165 patients in the R-CHOP arm and 169 in the R-CHOP plus RT arm. In an intent-to-treat analysis with a median follow-up of 64 months, 5-year EFS was not statistically significantly different between the 2 arms, with 89% ± 2.9% in the R-CHOP arm vs 92% ± 2.4% in the R-CHOP plus RT arm (hazard ratio, 0.61; 95% confidence interval [CI], 0.3-1.2; = .18). Overall survival was also not different at 92% (95% CI, 89.5%-94.5%) for patients assigned to R-CHOP alone and 96% (95% CI, 94.3%-97.7%) for those assigned to R-CHOP plus RT ( = not significant). R-CHOP alone is not inferior to R-CHOP followed by RT in patients with nonbulky limited-stage DLBCL. This trial was registered at www.clinicaltrials.gov as #NCT00841945.
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https://hal.archives-ouvertes.fr/hal-01635792
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Submitted on : Friday, March 16, 2018 - 11:52:19 AM
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Thierry Lamy, Gandhi Damaj, Pierre Soubeyran, Emmanuel Gyan, Guillaume Cartron, et al.. R-CHOP 14 with or without radiotherapy in non-bulky limited-stage diffuse large B-cell lymphoma (DLBCL). Blood, American Society of Hematology, 2018, 131 (2), pp.174-181. ⟨10.1182/blood-2017-07-793984⟩. ⟨hal-01635792⟩

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