Late toxicities in non-Hodgkin lymphoma: extended follow-up matters
Mené en Allemagne sur 275 patients atteints d'un lymphome agressif à cellules B à haut risque de récidive (âge : 18-60 ans), cet essai de phase III compare l'efficacité sur le long terme, du point de vue de la survie sans événement, et la toxicité d'une chimiothérapie conventionnelle (cyclosphosphamide, doxorubicine, vincristine, étoposide et prednisolone avec du rituximab) et d'un traitement de première ligne combinant chimiothérapie à hautes doses et rituximab suivi par une greffe autologue de cellules souches hématopoïétiques (durée médiane de suivi : 9,3 ans)
In The Lancet Haematology, Fabian Frontzek and colleagues report an impressive 10-year follow-up of the phase 3 DSHNHL 2002-1 trial, whichcompared R-CHOEP-14 (conventional chemotherapy [cyclosphosphamide, doxorubicin, vincristine,etoposide, and prednisolone] plus rituximab) with the dose-intensified regimen R-MegaCHOEP(high-dose chemotherapy plus rituximab followed by autologous haematopoietic stem-celltransplantation) in patients aged 18–60 years with high-risk aggressive B-cell non-Hodgkinlymphoma. The study affirms several observations about diffuse large B-cell lymphomaand its therapy: intensified chemotherapy is not associated with superior outcomes; relapse with indolent lymphoma is favorable; CNS relapses are associated with poor prognosis; and patients remaining in remission at 1–2 years after treatment have excellent outcomes. These findings are important, but not novel. The high merit of this report lies inits long follow-up, which eloquently underscores why and how cumulative and long-termtoxicities should be studied.
The Lancet Haematology , commentaire, 2020