Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis

Frederik O. Meeuwes; Mirian Brink; Marjolein W.M. van der Poel; Marie José Kersten; Mariëlle Wondergem; Pim G.N.J. Mutsaers; Lara Böhmer; Sherida Woei-A-Jin; Otto Visser; Rimke Oostvogels; Patty M. Jansen; Arjan Diepstra; Tjeerd J.F. Snijders; Wouter J. Plattel; Gerwin A. Huls; Joost S.P. Vermaat; Marcel Nijland

doi:10.1016/j.ejca.2022.09.008

Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis

Frederik O. Meeuwes
, Mirian Brink
, Marjolein W.M. van der Poel
, Marie José Kersten
, Mariëlle Wondergem
, Pim G.N.J. Mutsaers
, Lara Böhmer
, Sherida Woei-A-Jin
, Otto Visser
, Rimke Oostvogels
, Patty M. Jansen
, Arjan Diepstra
, Tjeerd J.F. Snijders
, Wouter J. Plattel
, Gerwin A. Huls
, Joost S.P. Vermaat
, Marcel Nijland^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Patients with angioimmunoblastic T-cell lymphoma (AITL) are treated with cyclophosphamide, doxorubicin, vincristine and prednisone with or without etoposide (CHO(E)P). In the majority of cases, Epstein-Barr virus (EBV)-positive B-cells are present in the tumour. There is paucity of research examining the effect of rituximab when added to CHO(E)P. In this nationwide, population-based study, we analysed the impact of rituximab on overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) of patients with AITL.

METHODS: Patients with AITL diagnosed between 2014 and 2020 treated with ≥one cycle of CHO(E)P with or without rituximab were identified in the Netherlands Cancer Registry. Survival follow-up was up to 1st February 2022. Baseline characteristics, best response during first-line treatment and survival were collected. PFS was defined as the time from diagnosis to relapse or to all-cause-death. OS was defined as the time from diagnosis to all-cause-death. Multivariable analysis for the risk of mortality was performed using Cox regression.

FINDINGS: Out of 335 patients, 146 patients (44%) received R-CHO(E)P. Rituximab was more frequently used in patients with a B-cell infiltrate (71% versus 89%, p < 0·01). The proportion of patients who received autologous stem cell transplantation (ASCT) was similar between CHO(E)P and R-CHO(E)P (27% versus 30%, respectively). The ORR and 2-year PFS for patients who received CHO(E)P and R-CHO(E)P were 71% and 78% (p = 0·01), and 40% and 45% (p = 0·12), respectively. The 5-year OS was 47% and 40% (p = 0·99), respectively. In multivariable analysis, IPI-score 3-5, no B-cell infiltrate and no ASCT were independent prognostic factors for risk of mortality, whereas the use of rituximab was not.

INTERPRETATION: Although the addition of rituximab to CHO(E)P improved ORR for patients with AITL, the PFS and OS did not improve.

Original language	English
Pages (from-to)	100-109
Number of pages	10
Journal	European Journal of Cancer
Volume	176
DOIs	https://doi.org/10.1016/j.ejca.2022.09.008
Publication status	Published - Nov 2022

Keywords

Angioimmunoblastic T-cell lymphoma
Outcome
Peripheral T-cell lymphoma
Rituximab
Treatment
Cyclophosphamide/therapeutic use
Prednisone/therapeutic use
Antibodies, Monoclonal, Murine-Derived/therapeutic use
Lymphoma, Large B-Cell, Diffuse/pathology
Humans
Neoplasm Recurrence, Local
Hematopoietic Stem Cell Transplantation
Transplantation, Autologous
Treatment Outcome
Herpesvirus 4, Human
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Rituximab/therapeutic use
Retrospective Studies
Epstein-Barr Virus Infections
Vincristine/therapeutic use
Doxorubicin/therapeutic use
Lymphoma, T-Cell/drug therapy

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Meeuwes, F. O., Brink, M., van der Poel, M. W. M., Kersten, M. J., Wondergem, M., Mutsaers, P. G. N. J., Böhmer, L., Woei-A-Jin, S., Visser, O., Oostvogels, R., Jansen, P. M., Diepstra, A., Snijders, T. J. F., Plattel, W. J., Huls, G. A., Vermaat, J. S. P., & Nijland, M. (2022). Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis. European Journal of Cancer, 176, 100-109. https://doi.org/10.1016/j.ejca.2022.09.008

@article{ca8f9608d09348b1b8c2436b0859b30c,

title = "Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis",

abstract = "BACKGROUND: Patients with angioimmunoblastic T-cell lymphoma (AITL) are treated with cyclophosphamide, doxorubicin, vincristine and prednisone with or without etoposide (CHO(E)P). In the majority of cases, Epstein-Barr virus (EBV)-positive B-cells are present in the tumour. There is paucity of research examining the effect of rituximab when added to CHO(E)P. In this nationwide, population-based study, we analysed the impact of rituximab on overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) of patients with AITL.METHODS: Patients with AITL diagnosed between 2014 and 2020 treated with ≥one cycle of CHO(E)P with or without rituximab were identified in the Netherlands Cancer Registry. Survival follow-up was up to 1st February 2022. Baseline characteristics, best response during first-line treatment and survival were collected. PFS was defined as the time from diagnosis to relapse or to all-cause-death. OS was defined as the time from diagnosis to all-cause-death. Multivariable analysis for the risk of mortality was performed using Cox regression.FINDINGS: Out of 335 patients, 146 patients (44\%) received R-CHO(E)P. Rituximab was more frequently used in patients with a B-cell infiltrate (71\% versus 89\%, p < 0·01). The proportion of patients who received autologous stem cell transplantation (ASCT) was similar between CHO(E)P and R-CHO(E)P (27\% versus 30\%, respectively). The ORR and 2-year PFS for patients who received CHO(E)P and R-CHO(E)P were 71\% and 78\% (p = 0·01), and 40\% and 45\% (p = 0·12), respectively. The 5-year OS was 47\% and 40\% (p = 0·99), respectively. In multivariable analysis, IPI-score 3-5, no B-cell infiltrate and no ASCT were independent prognostic factors for risk of mortality, whereas the use of rituximab was not.INTERPRETATION: Although the addition of rituximab to CHO(E)P improved ORR for patients with AITL, the PFS and OS did not improve.",

keywords = "Angioimmunoblastic T-cell lymphoma, Outcome, Peripheral T-cell lymphoma, Rituximab, Treatment, Cyclophosphamide/therapeutic use, Prednisone/therapeutic use, Antibodies, Monoclonal, Murine-Derived/therapeutic use, Lymphoma, Large B-Cell, Diffuse/pathology, Humans, Neoplasm Recurrence, Local, Hematopoietic Stem Cell Transplantation, Transplantation, Autologous, Treatment Outcome, Herpesvirus 4, Human, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Rituximab/therapeutic use, Retrospective Studies, Epstein-Barr Virus Infections, Vincristine/therapeutic use, Doxorubicin/therapeutic use, Lymphoma, T-Cell/drug therapy",

author = "Meeuwes, \{Frederik O.\} and Mirian Brink and \{van der Poel\}, \{Marjolein W.M.\} and Kersten, \{Marie Jos{\'e}\} and Mari{\"e}lle Wondergem and Mutsaers, \{Pim G.N.J.\} and Lara B{\"o}hmer and Sherida Woei-A-Jin and Otto Visser and Rimke Oostvogels and Jansen, \{Patty M.\} and Arjan Diepstra and Snijders, \{Tjeerd J.F.\} and Plattel, \{Wouter J.\} and Huls, \{Gerwin A.\} and Vermaat, \{Joost S.P.\} and Marcel Nijland",

note = "Funding Information: The authors would like to thank the registrars of the Netherlands Cancer Registry (NCR) for their dedicated data collection. The nationwide population-based NCR is maintained and hosted by the Netherlands Comprehensive Cancer Organisation (IKNL). Publisher Copyright: {\textcopyright} 2022 The Author(s)",

year = "2022",

month = nov,

doi = "10.1016/j.ejca.2022.09.008",

language = "English",

volume = "176",

pages = "100--109",

}

Meeuwes, FO, Brink, M, van der Poel, MWM, Kersten, MJ, Wondergem, M, Mutsaers, PGNJ, Böhmer, L, Woei-A-Jin, S, Visser, O, Oostvogels, R, Jansen, PM, Diepstra, A, Snijders, TJF, Plattel, WJ, Huls, GA, Vermaat, JSP & Nijland, M 2022, 'Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis', European Journal of Cancer, vol. 176, pp. 100-109. https://doi.org/10.1016/j.ejca.2022.09.008

TY - JOUR

T1 - Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis

AU - Meeuwes, Frederik O.

AU - Brink, Mirian

AU - van der Poel, Marjolein W.M.

AU - Kersten, Marie José

AU - Wondergem, Mariëlle

AU - Mutsaers, Pim G.N.J.

AU - Böhmer, Lara

AU - Woei-A-Jin, Sherida

AU - Visser, Otto

AU - Oostvogels, Rimke

AU - Jansen, Patty M.

AU - Diepstra, Arjan

AU - Snijders, Tjeerd J.F.

AU - Plattel, Wouter J.

AU - Huls, Gerwin A.

AU - Vermaat, Joost S.P.

AU - Nijland, Marcel

N1 - Funding Information: The authors would like to thank the registrars of the Netherlands Cancer Registry (NCR) for their dedicated data collection. The nationwide population-based NCR is maintained and hosted by the Netherlands Comprehensive Cancer Organisation (IKNL). Publisher Copyright: © 2022 The Author(s)

PY - 2022/11

Y1 - 2022/11

N2 - BACKGROUND: Patients with angioimmunoblastic T-cell lymphoma (AITL) are treated with cyclophosphamide, doxorubicin, vincristine and prednisone with or without etoposide (CHO(E)P). In the majority of cases, Epstein-Barr virus (EBV)-positive B-cells are present in the tumour. There is paucity of research examining the effect of rituximab when added to CHO(E)P. In this nationwide, population-based study, we analysed the impact of rituximab on overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) of patients with AITL.METHODS: Patients with AITL diagnosed between 2014 and 2020 treated with ≥one cycle of CHO(E)P with or without rituximab were identified in the Netherlands Cancer Registry. Survival follow-up was up to 1st February 2022. Baseline characteristics, best response during first-line treatment and survival were collected. PFS was defined as the time from diagnosis to relapse or to all-cause-death. OS was defined as the time from diagnosis to all-cause-death. Multivariable analysis for the risk of mortality was performed using Cox regression.FINDINGS: Out of 335 patients, 146 patients (44%) received R-CHO(E)P. Rituximab was more frequently used in patients with a B-cell infiltrate (71% versus 89%, p < 0·01). The proportion of patients who received autologous stem cell transplantation (ASCT) was similar between CHO(E)P and R-CHO(E)P (27% versus 30%, respectively). The ORR and 2-year PFS for patients who received CHO(E)P and R-CHO(E)P were 71% and 78% (p = 0·01), and 40% and 45% (p = 0·12), respectively. The 5-year OS was 47% and 40% (p = 0·99), respectively. In multivariable analysis, IPI-score 3-5, no B-cell infiltrate and no ASCT were independent prognostic factors for risk of mortality, whereas the use of rituximab was not.INTERPRETATION: Although the addition of rituximab to CHO(E)P improved ORR for patients with AITL, the PFS and OS did not improve.

AB - BACKGROUND: Patients with angioimmunoblastic T-cell lymphoma (AITL) are treated with cyclophosphamide, doxorubicin, vincristine and prednisone with or without etoposide (CHO(E)P). In the majority of cases, Epstein-Barr virus (EBV)-positive B-cells are present in the tumour. There is paucity of research examining the effect of rituximab when added to CHO(E)P. In this nationwide, population-based study, we analysed the impact of rituximab on overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) of patients with AITL.METHODS: Patients with AITL diagnosed between 2014 and 2020 treated with ≥one cycle of CHO(E)P with or without rituximab were identified in the Netherlands Cancer Registry. Survival follow-up was up to 1st February 2022. Baseline characteristics, best response during first-line treatment and survival were collected. PFS was defined as the time from diagnosis to relapse or to all-cause-death. OS was defined as the time from diagnosis to all-cause-death. Multivariable analysis for the risk of mortality was performed using Cox regression.FINDINGS: Out of 335 patients, 146 patients (44%) received R-CHO(E)P. Rituximab was more frequently used in patients with a B-cell infiltrate (71% versus 89%, p < 0·01). The proportion of patients who received autologous stem cell transplantation (ASCT) was similar between CHO(E)P and R-CHO(E)P (27% versus 30%, respectively). The ORR and 2-year PFS for patients who received CHO(E)P and R-CHO(E)P were 71% and 78% (p = 0·01), and 40% and 45% (p = 0·12), respectively. The 5-year OS was 47% and 40% (p = 0·99), respectively. In multivariable analysis, IPI-score 3-5, no B-cell infiltrate and no ASCT were independent prognostic factors for risk of mortality, whereas the use of rituximab was not.INTERPRETATION: Although the addition of rituximab to CHO(E)P improved ORR for patients with AITL, the PFS and OS did not improve.

KW - Angioimmunoblastic T-cell lymphoma

KW - Outcome

KW - Peripheral T-cell lymphoma

KW - Rituximab

KW - Treatment

KW - Cyclophosphamide/therapeutic use

KW - Prednisone/therapeutic use

KW - Antibodies, Monoclonal, Murine-Derived/therapeutic use

KW - Lymphoma, Large B-Cell, Diffuse/pathology

KW - Humans

KW - Neoplasm Recurrence, Local

KW - Hematopoietic Stem Cell Transplantation

KW - Transplantation, Autologous

KW - Treatment Outcome

KW - Herpesvirus 4, Human

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Rituximab/therapeutic use

KW - Retrospective Studies

KW - Epstein-Barr Virus Infections

KW - Vincristine/therapeutic use

KW - Doxorubicin/therapeutic use

KW - Lymphoma, T-Cell/drug therapy

UR - https://www.scopus.com/pages/publications/85139373118

U2 - 10.1016/j.ejca.2022.09.008

DO - 10.1016/j.ejca.2022.09.008

M3 - Article

C2 - 36208568

AN - SCOPUS:85139373118

SN - 0959-8049

VL - 176

SP - 100

EP - 109

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

Impact of rituximab on treatment outcomes of patients with angioimmunoblastic T-cell lymphoma; a population-based analysis

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