Rituximab and Dose-Dense Chemotherapy in Primary Testicular Lymphoma

Treatment of primary testicular lymphoma (PTL) remains unsatisfactory even in patients with good prognosis, as < 30% of patients are alive at 3 years. We began a phase II study to assess efficacy and toxicity of a dose-dense cyclophosphamide/epirubicin/vincristine/prednisone (CEOP14) regimen with rituximab (CEOP14R) in 38 previously untreated patients with PTL with early-stage (I or II) and low-risk disease, followed by adjuvant radiation therapy and central nervous system prophylaxis. Complete response was 86% (similar to historical controls), but improvement in outcome was observed; with actuarial curves at 5 years, event-free survival was 70%, and overall survival was 66%. Toxicity was mild, and the regimen was well tolerated. The addition of rituximab to dose-dense chemotherapy improves outcome in this setting of patients who previously had been considered to have the poorest prognosis. It is important that these findings will be validated in multicentric, controlled clinical trials.