Editor’s note: This article describes the results of a clinical trial—a research study with volunteer patients. The trial tested a new treatment for newly diagnosed diffuse large B-cell lymphoma (DLBCL). The new treatment consists of a combination of chemotherapy drugs known as R-CHOP, plus a new drug called lenalidomide (aka Revlimid). R-CHOP is a standard treatment for DLBCL. The results were promising, but more research will need to be done to figure out whether the new treatment is indeed better than the old. The results also showed that adding lenalidomide might work better for a certain sub-group of patients known as the non-GCB subtype.
“The combination of lenalidomide and R-CHOP demonstrated considerable activity in patients with newly diagnosed diffuse large B-cell lymphoma, according to results of a phase 2 study.
“The development of a more effective initial therapy is essential to improve long-term outcomes of patients with diffuse large B-cell lymphoma (DLBCL), Grzegorz S. Nowakowski, MD, of the division of hematology at Mayo Clinic in Rochester, Minn., and colleagues wrote.
“Prior studies demonstrated lenalidomide (Revlimid, Celgene) has considerable single-agent activity in relapsed DLBCL. Lenalidomide also can be combined with R-CHOP — which consists of rituximab (Rituxan; Genentech, Biogen Idec), cyclophosphamide, doxorubicin, vincristine and prednisone) — to form a novel combination known as R2CHOP.
“In the current study, Nowakowski and colleagues evaluated the efficacy of R2CHOP in 60 patients with newly diagnosed DLBCL. The median age of patients was 65 years; 70% were aged older than 60 years, and 9% were aged ≥80 years.”
“Vitamin D deficiency (VDD) contributes to worse outcomes in elderly patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab, according to a study published online Aug. 18 in the Journal of Clinical Oncology.
“Jörg Thomas Bittenbring, MD, from Universitätsklinikum des Saarlandes in Germany, and colleagues examined the impact and mechanisms of VDD in patients with DLBCL. Chemoluminescent immunoassays were used to evaluate 359 pretreatment 25-hydroxyvitamin D3 serum levels from the RICOVER-60 study (6 Versus 8 Cycles of Biweekly CHOP-14 With or Without Rituximab) and 63 from the RICOVER-noRTh study (an amendment to the RICOVER-60 study).
“The researchers found that RICOVER-60 patients treated with rituximab with VDD (≤8 ng/mL) had 3-year event-free survival (EFS) of 59% and 3-year overall survival (OS) of 70%, while those with vitamin D levels >8 ng/mL treated with rituximab had EFS and OS of 79 and 82%, respectively. In multivariate analysis adjusting for International Prognostic Index risk factors, these differences remained significant, with hazard ratios of 2.1 (P = 0.008) for EFS and 1.9 (P = 0.040) for OS. In all 7 individuals with VDD, there were significant increases in rituximab-mediated cellular cytotoxicity (RMCC; P < 0.001) after substitution and normalization of their vitamin D levels.”
“Scientists at the Department of Haematology and Oncology at the Nagoya Daini Red Cross Hospital in Japan have concluded that a drug called Zolinza (vorinostat) may improve outcomes for patients fighting indolent B-cell lymphomas like follicular lymphoma and mantle cell lymphoma.”