CHARACTERISTICS AND OUTCOME OF PATIENTS WITH DIFFUSE LARGE B CELL LYMPHOMA-TREATED WITH CHEMOTHERAPY OR CHEMO-IMMUNOTHERAPY

Maria Qubtia, Kiran Munawar, Mustafa Ali Hamid, Farhana Badar, Neelam Siddiqui, Syed Ather Kazmi, Abdul Hameed

Abstract


Background: Diffuse large-B-cell lymphoma, is the most common subtype of Non-Hodgkin lymphoma. Aim of this study was to look at the characteristics and outcome of DLBCL patients who were treated with chemotherapy or chemotherapy plus rituximab at our institution. Methods: Data of 750 patients, who got registered at our institute between 2007 and 2014, was reviewed retrospectively. After appropriate exclusions, 337 were included. Disease free survival (DFS) and overall survival (OS) were compared between patients who received rituximab plus CHOP (Cyclophosphamide, Doxorubicine, Vincristine, Prednisolon) (R-Ch) and standard chemotherapy-CHOP (S-Ch). Results: Males and females were 216 (64%) and 121 (36%) respectively, with median age 38 years (Range 18–80 yrs.). R-Ch and S.Ch was received by 129(38.3%) and 197(58.4%) patients, respectively. Complete remission (CR) was achieved by 81 (62.8%) vs. 105 (53.3%) patients in R-Ch vs. S-Ch cohorts, respectively. In subset analysis CR was seen in 34 (63.0%) and 45 (58.4%) (p=0.01) in R-Ch/XRT and S-Ch/XRT, respectively. At three years, DFS was 85.3% vs. 74% (p=0.04) and OS was 82.2% vs. 72.6% (p=0.02) in R-Ch and S-Ch cohorts respectively. Deaths observed were 9 Vs.13 in R-Ch/XRT and S-Ch/XRT, respectively. Conclusion: Based on our study, onset of DLBCL is at younger age in our population with male predominance. Addition of rituximab to CHOP resulted in better DFS and OS in patients with DLBCL. In developing countries, due to cost, large number of patients do not have access to rituximab. Efforts should be made to reduce the price of targeted therapies so that more and more patients are benefitted from these newer agents.

Keywords:DLBCL, CHOP, Rituximab, DFS, OS

 


Full Text:

PDF

References


Athar S, Siddiqui N, Rai SR, Muzaffar N, Hameed A. Impact of rituximab and IPI on survival in diffuse large B cell lymphoma patients treated at a tertiary level cancer centre in pakistan: A single-centre experience. J Pak Med Assoc 2015:65(2):170-174.

Bellas C, Garcia D, Vicente Y, Kilany L, Abraira V, Navarro B, et al. Immunohistochemical and molecular characteristics with prognostic significance in diffuse large B-cell lymphoma. PLoS One 2014:9(6):e98169.

Hoefnagel JJ, Dijkman R, Basso K ,Jansen PM, Hallermann C, Willemze R, et al. Distinct types of primary cutaneous large B-cell lymphoma identified by gene expression profiling. Blood 2005;105(9):3671–8.

Huang HH, Xiao F, Chen FY, Wang T, Li JM, Wang JM, et al. Reassessment of the prognostic value of the international prognostic index and the revised international prognostic index in patients with diffuse large B-cell lymphoma: A multicentre study. Exp Ther Med 2012;4(3):475–80.

Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, et al. The revised international prognostic index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 2007;109(5):1857–61.

Gordon LI, Harrington D, Andersen J, Colgan J, Glick J , Neiman R, et al. Comparison of a second-generation combination chemotherapeutic regimen (m-BACOD) with a standard regimen (CHOP) for advanced diffuse non-hodgkin's lymphoma. N Engl J Med 1992;327(19):1342–9.

Kimby E, Brandt L, Nygren P, Glimelius B. A systematic overview of chemotherapy effects in aggressive non-hodgkin's lymphoma. Acta Oncol 2001;40(2-3):198–212.

Haioun C, Lepage E, Gisselbrecht C, Salles G, Coiffier B, Brice P, et al. Survival benefit of high-dose therapy in poor-risk aggressive non-hodgkin's lymphoma: Final analysis of the prospective LNH87-2 protocol--a groupe d'etude des lymphomes de l'adulte study. J Clin Oncol 2000;18(16):3025–30.

Okamoto A, Yanada M, Inaguma Y, Tokuda M, Morishima S, Kanie T, Y, et al. Differences in outcome for consecutive patients with diffuse large B-cell lymphoma before and after the advent of rituximab: A single-center experience. Hematology 2013;18(2):74–80.

Coiffier B, Thieblemont C, Van Den Neste E, Lepeu G, Plantier I, Castaigne S, et al. Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: A study by the groupe d'etudes des lymphomes de l'adulte. Blood 2010;116(12):2040–5.

McLaughlin P, Grillo-Lopez AJ, Link BK, Lew R, Czuczman MS, Williams ME, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: Half of patients respond to a four-dose treatment program. J Clin Oncol 1998;16(8):2825–33.

Suresh T, Lee LX, Joshi J, Barta SK. New antibody approaches to lymphoma therapy. J Hematol Oncol 2014;7:58.

Bonavida B. Postulated mechanisms of resistance of B-cell non-hodgkin lymphoma to rituximab treatment regimens: Strategies to overcome resistance. Semin Oncol 2014;41(5):667–77.

Marquez ME, Hernandez-Uzcategui O, Cornejo A, Vargas P, Da Costa O. Bone marrow stromal mesenchymal cells induce down regulation of CD20 expression on B-CLL: Implications for rituximab resistance in CLL. Br J Haematol 2015;169(2):211–8.

Naz E, Mirza T, Aziz S, Danish F, Siddiqui ST, Ali A. Frequency and clinicopathologic correlation of different types of non-Hodgkin’s lymphoma according to WHO classification. J Pak Med Assoc 2011;61(3):260–3.

Redondo AM, Pomares H, Vidal MJ, Pascual MJ, Quereda B, Sancho JM, et al. Impact of prior rituximab on outcomes of autologous stem-cell transplantation in patients with relapsed or refractory aggressive B-cell lymphoma: a multicentre retrospective Spanish group of lymphoma/autologous bone marrow transplant study. Br J Haematol 2014;164(5):668–74.

Luo B, Huang J, Yan Z, Zhao W, Wang L. Clinical and prognostic analysis of 21 cases of primary breast lymphoma. Zhonghua Xue Ye Xue Za Zhi 2015;36(4):277–81.

Zucca E, Conconi A, Mughal TI, Sarris AH, Seymour JF, Vitolo U, et al. Patterns of outcome and prognostic factors in primary large -cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group. J Clin Oncol 2003;21(1):20–7.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]