Top Line: Does consolidative radiation improve survival for younger patients with aggressive B-cell lymphoma?
The Study: R-MegaCHOEP was a randomized trial that compared standard-dose chemotherapy (R-CHOEP) with high-dose chemotherapy and stem cell transplant (R-MegaCHOEP) in patients 60 or younger with high risk (IPI 2 or 3), aggressive B-cell lymphoma. The protocol mandated that patients in both arms with bulky (≥7.5cm) or extranodal disease receive 36 Gy consolidative radiation to those sites after completing systemic therapy. This secondary analysis compared outcomes of those who received RT (46%) with those who didn’t. Patients who received RT typically had worse clinical features with the exception of a slightly larger proportion of stage I/II patients whose main risk factor was bulky disease (7% v 1%). Patients who received RT had significantly better EFS (64% v 46%) and PFS (67% v 54%) at 10 years. This seemed to be driven mainly by the subset of patients with bulky disease rather than extranodal disease. In the former group, RT improved not only EFS (64% v 35%) and PFS (68% v 47%) but also OS (72% v 59%). Further subgroup analysis seemed to point towards those with an IPI of 2 and those without a CR as the biggest beneficiaries of consolidative RT. There was no difference in toxicity or second malignancy with or without RT.
TBL: This secondary analysis of a prospective trial found that patients with bulky, aggressive B-cell lymphoma who received consolidative RT had better survival outcomes than patients with non-bulky disease who didn’t get RT. | Oertel, Leukemia 2024
The Study: R-MegaCHOEP was a randomized trial that compared standard-dose chemotherapy (R-CHOEP) with high-dose chemotherapy and stem cell transplant (R-MegaCHOEP) in patients 60 or younger with high risk (IPI 2 or 3), aggressive B-cell lymphoma. The protocol mandated that patients in both arms with bulky (≥7.5cm) or extranodal disease receive 36 Gy consolidative radiation to those sites after completing systemic therapy. This secondary analysis compared outcomes of those who received RT (46%) with those who didn’t. Patients who received RT typically had worse clinical features with the exception of a slightly larger proportion of stage I/II patients whose main risk factor was bulky disease (7% v 1%). Patients who received RT had significantly better EFS (64% v 46%) and PFS (67% v 54%) at 10 years. This seemed to be driven mainly by the subset of patients with bulky disease rather than extranodal disease. In the former group, RT improved not only EFS (64% v 35%) and PFS (68% v 47%) but also OS (72% v 59%). Further subgroup analysis seemed to point towards those with an IPI of 2 and those without a CR as the biggest beneficiaries of consolidative RT. There was no difference in toxicity or second malignancy with or without RT.
TBL: This secondary analysis of a prospective trial found that patients with bulky, aggressive B-cell lymphoma who received consolidative RT had better survival outcomes than patients with non-bulky disease who didn’t get RT. | Oertel, Leukemia 2024