Evidence map›Paper›PMID 32464282›Full record

Trial reportAnnals of oncology : official journal of the European Society for Medical Oncology2020

Favourable outcomes for high-risk diffuse large B-cell lymphoma (IPI 3-5) treated with front-line R-CODOX-M/R-IVAC chemotherapy: results of a phase 2 UK NCRI trial.

A K McMillan, E H Phillips, A A Kirkwood, S Barrans, C Burton, S Rule, R Patmore, R Pettengell, K M Ardeshna, A Lawrie and 4 more

Registry-linked trialOpen access · hybridAbstract readClinical Trial, Phase II
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Annals of oncology : official journal of the European Society for Medical Oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00974792 (A Phase II Single Arm Study of the Use of CODOX-M/IVAC With Rituximab), which is not on this map. Cited by 31 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 2 pooled it
5.7field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00974792 phase2unknown statusnot on this map

A Phase II Single Arm Study of the Use of CODOX-M/IVAC With Rituximab (R-CODOX-M/IVAC) in the Treatment of Patients With Diffuse Large B-Cell Lymphoma (International Prognostic Index High or High-Intermediate Risk)

TypeinterventionalSponsorCancer Research UKRan2006Enrolled150ConditionsLymphomaArmspegfilgrastim, rituximab, cyclophosphamide, cytarabine, doxorubicin hydrochloride
3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 2 syntheses or guidelines pooled it, 55 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
  8. Observational
  9. High-grade B-cell lymphomas: high difficulties to diagnose and treat?Hematology. American Society of Hematology. Education Program · 2025
    Review
  10. Article
  11. Article
  12. CODOX-M/IVAC-RHaematologica · 2025
    Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 9 institutions in 1 country.

A K McMillanHaematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK. Electronic address: andrew.mcmillan@nuh.nhs.uk.
E H PhillipsCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK; Division of Cancer Sciences, University of Manchester and The Christie Hospital NHS Trust, Manchester, UK.
A A KirkwoodCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK.
S BarransHMDS, St James' University Hospital, Leeds, UK.
C BurtonHMDS, St James' University Hospital, Leeds, UK.
S RulePlymouth University Medical School, Plymouth, UK.
R PatmoreHaematology Department, Castle Hill Hospital, Hull, UK.
R PettengellClinical Sciences, St George's University of London, London, UK.
K M ArdeshnaHaematology Department, University College Hospital London, London, UK.
A LawrieCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK.
S MontotoCentre for Haemato-oncology, Barts Health NHS Trust, London, UK.
S PaneeshaHaematology Department, Heart of England NHS Trust, Birmingham, UK.
L Clifton-HadleyCancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, University College London, London, UK.
D C LinchHaematology Department, University College Hospital London, London, UK; UCL Cancer Institute, University College London, UK.
Cancer Research UK · GBUniversity College London · GBSt James's University Hospital · GBBarts Health NHS Trust · GBCastle Hill Hospital · GBHeart of England NHS Foundation Trust · GBNottingham University Hospitals NHS Trust · GBSt George's, University of London · GBUniversity of Plymouth · GB

Funding

Cancer Research UK
6 · The paper itself

Abstract

backgroundOutcomes for patients with high-risk diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP chemotherapy are suboptimal but, to date, no alternative regimen has been shown to improve survival rates. This phase 2 trial aimed to assess the efficacy of a Burkitt-like approach for high-risk DLBCL using the dose-intense R-CODOX-M/R-IVAC regimen. PATIENTS AND

methodsEligible patients were aged 18-65 years with stage II-IV untreated DLBCL and an International Prognostic Index (IPI) score of 3-5. Patients received alternating cycles of CODOX-M (cyclophosphamide, vincristine, doxorubicin and high-dose methotrexate) alternating with IVAC chemotherapy (ifosfamide, etoposide and high-dose cytarabine) plus eight doses of rituximab. Response was assessed by computed tomography after completing all four cycles of chemotherapy. The primary end point was 2-year progression-free survival (PFS).

resultsA total of 111 eligible patients were registered; median age was 50 years, IPI score was 3 (60.4%) or 4/5 (39.6%), 54% had a performance status ≥2 and 9% had central nervous system involvement. A total of 85 patients (76.6%) completed all four cycles of chemotherapy. There were five treatment-related deaths (4.3%), all in patients with performance status of 3 and aged >50 years. Two-year PFS for the whole cohort was 67.9% [90% confidence interval (CI) 59.9-74.6] and 2-year overall survival was 76.0% (90% CI 68.5-82.0). The ability to tolerate and complete treatment was lower in patients with performance status ≥2 who were aged >50 years, where 2-year PFS was 43.5% (90% CI 27.9-58.0).

conclusionsThis trial demonstrates that R-CODOX-M/R-IVAC is a feasible and effective regimen for the treatment of younger and/or fit patients with high-risk DLBCL. These encouraging survival rates demonstrate that this regimen warrants further investigation against standard of care.

trial registrationClinicalTrials.gov (NCT00974792) and EudraCT (2005-003479-19).

Indexed as

Burkitt LymphomaLymphoma, Large B-Cell, DiffuseAdolescentAdultAgedAntineoplastic Combined Chemotherapy ProtocolsCyclophosphamideDisease-Free SurvivalDoxorubicinHumansIfosfamideMiddle AgedPrednisoneRituximabUnited KingdomVincristineCyclophosphamideDoxorubicinIfosfamidePrednisoneRituximabVincristinechemotherapydiffuse large B-cell lymphoma (DLBCL)double-hithigh-grade B-cell lymphomaR-CODOX-M

Identifiers

PMID32464282
PMCPMC7487775
OpenAlexW3026055638

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.