Clinicopathological analysis of primary refractory diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone chemoimmunotherapy.

Abstract

BACKGROUND:

Approximately 15% of patients with diffuse large B-cell lymphoma (DLBCL) experience refractory or early relapsed disease after initial rituximab-containing chemoimmunotherapy is regarded as a primary refractory disease. Although the standard treatment for relapsed DLBCL is high-dose chemotherapy and autologous stem cell transplantation (HDC-ASCT), the efficacy of this approach for primary refractory DLBCL is not well understood. We aimed to investigate the clinicopathological characteristics and outcomes of patients with primary refractory DLBCL.

METHODS:

Sixty-nine consecutive patients with primary refractory DLBCL who were treated at our institution were categorized as partial responders (partial response to rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone [R-CHOP] or relapse within 6 months of R-CHOP) (n = 41) or primary progressors (no response to R-CHOP) (n = 28). Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test.

RESULTS:

At initial diagnosis, 70% of patients had Ann Arbor stage III/IV disease, 56% had non-germinal center B-cell-like type DLBCL, and 42% had double-expressor lymphoma (MYC and BCL2 expression). The 3-year overall survival rate was significantly poorer in the primary progressors group than in the partial responders' group (15% vs. 48%, p < 0.001). Four of 17 patients treated with HDC-ASCT were primary progressors; only one patient survived without relapse. Although double-expressor lymphoma status did not significantly impact overall survival among all patients (p = 0.794), it was identified as an independent poor prognostic factor in HDC-ASCT-treated patients (p = 0.002).

CONCLUSIONS:

We identified a subgroup of patients with primary refractory DLBCL who may not benefit from current treatment strategies. Further treatment development is needed to improve the outcomes of these patients.

• Authors: Tomotaka Suzuki, Dai Maruyama, Akiko Miyagi-Maeshima, Junko Nomoto, Kinuko Tajima, Yuta Ito, Shunsuke Hatta, Sayako Yuda, Shinichi Makita, Suguru Fukuhara, Wataru Munakata, Tatsuya Suzuki, Hirokazu Taniguchi, Koji Izutsu, Yukio Kobayashi, Kensei Tobinai
• Journal: Cancer medicine (Cancer Med) Vol. 10 Issue 15 Pg. 5101-5109 (08 2021) ISSN: 2045-7634 [Electronic] United States
• PMID: 34105893 (Publication Type: Journal Article)
• Copyright: © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Chemical References

• Antineoplastic Agents, Immunological
• BCL2 protein, human
• MYC protein, human
• Proto-Oncogene Proteins c-bcl-2
• Proto-Oncogene Proteins c-myc
• R-CHOP protocol
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Immunological (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cyclophosphamide (therapeutic use)
• Disease Progression
• Doxorubicin (therapeutic use)
• Drug Resistance, Neoplasm
• Female
• Humans
• Immunotherapy (methods)
• Kaplan-Meier Estimate
• Lymphoma, Large B-Cell, Diffuse (drug therapy, mortality)
• Male
• Middle Aged
• Prednisone (therapeutic use)
• Proto-Oncogene Proteins c-bcl-2 (metabolism)
• Proto-Oncogene Proteins c-myc (metabolism)
• Recurrence
• Retrospective Studies
• Rituximab (therapeutic use)
• Salvage Therapy (methods)
• Survival Rate
• Treatment Outcome
• Vincristine (therapeutic use)
• Young Adult