Rituximab treatment for elderly patients with aggressive B-cell lymphomas

This study looked at the impact of rituximab treatment and gene mutations on the outcomes for elderly patients who did not respond to first line chemotherpy. The study concluded that patients who experienced treatment failure after first line rituximab and chemotherapy had poor outcomes, but rituximab improved patient outcomes when given as second line therapy. 

Rituximab therapy has greatly improved survival rates for patients with aggressive B-cell lymphomas. However, some patients still experience treatment failure after first line treatment. Treatment failure means that the treatment (such as chemotherapy) is no longer able to kill tumor cells. This means that the cancer can come back and will need to be treated with different chemotherapy. Few studies have directly examined second-line treatment in older patients.

Patients who experience treatment failure often have poor outcomes. Mutations in certain genes, such as the MYC, bcl-2, and bcl-6 genes, may increase the risk for treatment failure.

This study looks at some of the risk factors that may make treatment failure more likely in elderly patients who fail first-line therapy. 

The medical records of 1222 patients were reviewed. 301 (24.6%) of the patients experienced treatment failure after first line chemotherapy. All patients in this study were over 60 years old. The average length of follow up was 34.5 months.

31.2% of patients who were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) alone experienced treatment failure. 18% of patients treated with rituximab plus CHOP (R-CHOP) experienced treatment failure. The difference was statistically significant.

The average overall survival length after treatment failure (time from treatment failure to death from any cause) was 14.2 months in the R-CHOP group. The average overall survival length after treatment failure was 18.5 months for CHOP patients. The 2-year survival rate after treatment failure was significantly lower for the R-CHOP group (23%) compared to the CHOP group (36.4%).

Rituximab significantly improved the outcomes for patients with the MYC gene mutation. Being treated with rituximab for first line therapy reduced the risk of treatment failure from 58.8% to 26.3%.

The 2-year survival rate for patients who received rituximab as part of second line therapy was 46.8%. The 2-year survival rate for patients who were not treated with rituximab as part of second line therapy was 20.7%. 

The authors concluded that patents who experience treatment failure after being treated with first line rituximab have poor outcomes, but patients with an MYC mutation can benefit from first line rituximab. Also, rituximab given as second line therapy improves outcomes in elderly patients.