***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This study compared the induction regimens doxorubicin , cyclophosphamide and etoposide ( ACE ) with doxorubicin , cyclophosphamide , vincristine , bleomycin and prednisone ( ACVBP ) before high-dose therapy ( HDT ) followed by autologous stem-cell transplantation ( ASCT ) for patients with poor-risk diffuse large B-cell lymphoma ( DLBCL ) . A second r and omisation compared rituximab with observation post-ASCT . MATERIAL S AND METHODS Four hundred and seventy-six patients < 60 years old with newly diagnosed CD20 + DLBCL were r and omised to induction with ACE or ACVBP . Three hundred and thirty responders received HDT followed by ASCT . After ASCT , 269 patients were re-r and omised to receive either maintenance rituximab or observation alone . R and omisation was stratified by the quality of response to ASCT . The primary end point of this study was event-free survival ( EFS ) . RESULTS At a median of 4 years ' follow-up from the second r and omisation , there was a trend ( P = 0.1 ) towards increased EFS for patients who received rituximab compared with observation . CONCLUSION The type of induction therapy ( ACVBP or ACE ) did not significantly affect overall survival at a median 51 months ' follow-up Background Patients with diffuse large B-cell lymphoma ( DLBCL ) with an International Prognostic Index ( IPI ) ≥3 are at higher risk for relapse after a complete response ( CR ) to first-line rituximab-based chemotherapy ( R-chemo ) . Everolimus has single-agent activity in lymphoma . PILLAR-2 aim ed to improve disease-free survival ( DFS ) with 1 year of adjuvant everolimus . Patients and methods Patients with high-risk ( IPI ≥3 ) DLBCL and a positron emission tomography/computed tomography-confirmed CR to first-line R-chemo were r and omized to 1 year of everolimus 10 mg/day or placebo . The primary end point was DFS ; secondary end points were overall survival , lymphoma-specific survival , and safety . Results Between August 2009 and December 2013 , 742 patients were r and omized to everolimus ( n = 372 ) or placebo ( n = 370 ) . Median follow-up was 50.4 months ( range 24.0 - 76.9 ) . Overall , 47 % of patients were ≥65 years , 50 % were male , and 42 % had an IPI of 4 or 5 . 48 % and 67 % completed everolimus and placebo , respectively . Primary reasons for everolimus discontinuation versus placebo were adverse events ( AEs ; 30 % versus 12 % ) and relapsed disease ( 6 % versus 13 % ) . Everolimus did not significantly improve DFS compared with placebo ( hazard ratio 0.92 ; 95 % CI 0.69 - 1.22 ; P = 0.276 ) . Two-year DFS rate was 77.8 % ( 95 % CI 72.7 - 82.1 ) with everolimus and 77.0 % ( 95 % CI 72.1 - 81.1 ) with placebo . Common grade 3/4 AEs with everolimus were neutropenia , stomatitis , and decreased CD4 lymphocytes . Conclusions Adjuvant everolimus did not improve DFS in patients already in PET/CT-confirmed CR . Future approaches should incorporate targeted agents such as everolimus with R-CHOP rather than as adjuvant therapy after CR has been obtained . Clinical Trials.gov NCT00790036 Purpose The st and ard treatment of patients with diffuse large B-cell lymphoma ( DLBCL ) is rituximab in combination with cyclophosphamide , doxorubicin , vincristine , and prednisone ( R-CHOP ) . Lenalidomide , an immunomodulatory agent , has shown activity in DLBCL . This r and omized phase III trial compared lenalidomide as maintenance therapy with placebo in elderly patients with DLBCL who achieved a complete response ( CR ) or partial response ( PR ) to R-CHOP induction . Methods Patients with previously untreated DLBCL or other aggressive B-cell lymphoma were 60 to 80 years old , had CR or PR after six or eight cycles of R-CHOP , and were r and omly assigned to lenalidomide maintenance 25 mg/d or placebo for 21 days of every 28-day cycle for 24 months . The primary end point was progression-free survival ( PFS ) . Results A total of 650 patients were r and omly assigned . At the time of the primary analysis ( December 2015 ) , with a median follow-up of 39 months from r and om assignment , median PFS was not reached for lenalidomide maintenance versus 58.9 months for placebo ( hazard ratio , 0.708 ; 95 % CI , 0.537 to 0.933 ; P = .01 ) . The result was consistent among analyzed subgroups ( eg , male v female , age-adjusted International Prognostic Index 0 or 1 v 2 or 3 , age younger than 70 v ≥ 70 years ) , response ( PR v CR ) after R-CHOP , and positron emission tomography status at assignment ( negative v positive ) . With longer median follow-up of 52 months ( October 2016 ) , overall survival was similar between arms ( hazard ratio , 1.218 ; 95 % CI , 0.861 to 1.721 ; P = .26 ) . Most common grade 3 or 4 adverse events associated with lenalidomide versus placebo maintenance were neutropenia ( 56 % v 22 % ) and cutaneous reactions ( 5 % v 1 % ) , respectively . Conclusion Lenalidomide maintenance for 24 months after obtaining a CR or PR to R-CHOP significantly prolonged PFS in elderly patients with DLBCL Diffuse large B-cell lymphoma ( DLBCL ) is a heterogeneous entity , with patients exhibiting a wide range of outcomes . The addition of rituximab to CHOP chemotherapy (R-CHOP)has led to a marked improvement in survival and has called into question the significance of previously recognized prognostic markers . Since r and omized controlled trials of R-CHOP in DLBCL have included select subgroups of patients , the utility of the International Prognostic Index ( IPI ) has not been reassessed . We performed a retrospective analysis of patients with DLBCL treated with R-CHOP in the province of British Columbia to assess the value of the IPI in the era of immunochemotherapy . The IPI remains predictive , but it identifies only 2 risk groups . Redistribution of the IPI factors into a revised IPI ( R-IPI ) provides a more clinical ly useful prediction of outcome . The R-IPI identifies 3 distinct prognostic groups with a very good ( 4-year progression-free survival [ PFS ] 94 % , overall survival [ OS ] 94 % ) , good ( 4-year PFS 80 % , OS 79 % ) , and poor ( 4-year PFS 53 % , OS 55 % ) outcome , respectively ( P < .001 ) . The IPI ( or R-IPI ) no longer identifies a risk group with less than a 50 % chance of survival . In the era of R-CHOP treatment , the R-IPI is a clinical ly useful prognostic index that may help guide treatment planning and interpretation of clinical trials OBJECTIVES We conducted a r and omized clinical trial to evaluate the role of interferon alfa 2b ( IFN ) as maintenance therapy in patients with diffuse large B-cell lymphoma with high or high-intermediate clinical risk on complete remission ( CR ) after CHOP-BLEO regimens . METHODS Patients were initially treated with CHOP-BLEO regimens ( which include increased doses of cyclophosphamide and epirubicine , instead of doxorubicin ) . If the patients achieved CR they were r and omly assigned to receive either maintenance therapy with IFN 5.0 MU , three times at week by 1 yr , or no treatment ( control group ) . RESULTS Two hundred and twenty-three patients were considered as c and i date s for the study . They were of high ( 80 % ) or high-intermediate ( 20 % ) clinical risk ; additionaly most patients had poor prognostic factors such as high levels of beta 2 microglobulin , lactic dehydrogenase levels , bulky disease ( defined as a tumor mass > 10 cm ) or multiple extranodal involvement . In an intent-to-treat analysis all patients were evaluable to efficacy and toxicity . Median follow-up was 45 months , the estimated 5-yr overall survival and event-free survival ( EFS ) for patients who received IFN were 71 % ( 95 % confidence interval ( CI ) : 61 - 83 % ) and 57 % ( 95 % CI : 39 - 69 % ) , respectively , values which were not statistically different from the control group : 69 % ( 95 % CI : 63 - 79 % ) and 54 % ( 95 % CI : 37 - 63 % ) , respectively ( p=0.2 ) . Toxicity was mild . CONCLUSIONS These results suggest that IFN used as maintenance therapy at these doses and schedules is not useful in aggressive malignant lymphoma when more intensive chemotherapy has been employed during induction treatment . Nevertheless , follow-up is too short , and long-term follow-up would be necessary in order to draw definitive conclusions . Probably , an multicenter study is necessary to define the role of IFN as maintenance therapy in this patient setting Maintenance therapy in patients with aggressive malignant lymphoma using biological modifiers remains uncertain . We conducted a controlled clinical trial to evaluate the efficacy and toxicity of interferon-alpha 2b , cyclophosphamide , and prednisone as maintenance therapy in patients with aggressive diffuse large B cell lymphomas in complete remission after aggressive chemotherapy . In an intent-to-treat analysis , 169 patients were eligible for this study ; the end points were event-free survival ( EFS ) and overall survival ( OS ) . With a median follow-up of 49.3 months , no statistical differences were observed and actuarial curves at 5 years showed that EFS was 71 % ( 95 % confidence interval [ CI ] , 63 - 79 % ) for patients who received maintenance compared to 63 % ( 95 % CI , 59 - 71 % ) for patients in control group ( p = 0.05 ) . No statistical differences were observed in OS between maintenance arm : 84 % ( 95 % CI , 78 - 89 % ) and control group 83 % ( 95 % CI , 77 - 88 % ) in control group ( p = 0.2 ) . All patients received the maintenance therapy as planned and in time , thus dose intensity was considered 1.0 in all cases . Acute toxicity was mild , and no delay or suspension of treatment was necessary . Late toxicity was not evident until now . We conclude that use of maintenance therapy combining interferon-alpha 2b , cyclophosphamide , and prednisone is not useful in patients with aggressive lymphoma if they had been treated with aggressive combined chemotherapy To assess the efficacy and toxicity of interferon alfa 2b ( IFN ) as maintenance therapy in patients with malignant lymphoma on complete response after conventional chemotherapy we start a r and omized clinical trial . One hundred and seventy patients were r and omized to received either IFN 5.0 MU three time at week by one year or no further treatment , as control group . At a median follow-up of 9.0 years ( range 4.3 to 11 years ) median freedom from relapse ( FFR ) has not been reached in patients who received IFN , it is statistically significant to patients in control group with a median FFR of 60 months ( p < .001 ) . Actuarial curves show that at 10-years , 58 patients ( 66 % , 95 % confidence interval ( CI ) 53 % to 79 % ) remain in first remission , statistical different to control group 33 patients ( 40 % , 95 % Cl : 33 % to 57 % ) ( p < .001 ) . Event free survival ( EFS ) shown that a 10-years 63 patients ( 71 % , 95 % CI : 59 % to 81 % ) are alive free of disease in the IFN arm compared to only 38 patients ( 45 % , 95 % CI : 37 % to 57 % ) in the control group ( p < .001 ) . Toxicity was mild , 81 patients received the planned doses of IFN on time and 6 patients had transitory delay secondary to hematological toxicity ( grade 1 or 2 ) and completed the treatment on 13 months . No late side effects has been observed . After a long term follow-up we confirm that IFN used as maintenance therapy improves outcome in patients with aggressive malignant lymphoma who were in complete remission after conventional chemotherapy without excessive toxicity . We feld that IFN will be consider in controlled clinical trials to define the role of this therapeutic option Background : The correlation between efficacy end points in r and omized controlled trials ( RCTs ) of systemic therapy for non-Hodgkin 's lymphoma ( NHL ) was investigated to identify an appropriate surrogate end point for overall survival ( OS ) 
    Output:
    
MT in patients with DLBCL achieving CR or PR after induction therapy did not affect OS , yet it decreased relapse rate and improved disease control at the cost of higher infection rate .
Our data do not support routine administration of MT in patients with DLBCL