Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma: a Swedish Lymphoma Registry study.

Abstract

Young patients with diffuse large B-cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP), CHOP-etoposide (R-CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R-HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aaIPI) ≥ 2, the 5-year overall survival (OS) was 70%, 76% and 85% after R-CHOP, R-CHOEP and R-HDA/M, respectively (P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aaIPI = 3 (P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI ≥ 2: three were "Moderate" (more R-CHOP) and three "Intensive" (more R-CHOEP and R-HDA/M). Patients with aaIPI ≥ 2 who were treated in the Intensive Regions, showed better OS (P < 0·00005), particularly those with aaIPI = 3 (5-year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aaIPI < 2. We conclude that in younger high-risk patients, survival appears superior after more intensive therapy than R-CHOP.

• Authors: Christopher M Melén, Gunilla Enblad, Kristina Sonnevi, Henna Riikka Junlén, Karin E Smedby, Mats Jerkeman, Björn Engelbrekt Wahlin
• Journal: British journal of haematology (Br J Haematol) Vol. 175 Issue 4 Pg. 614-622 (Nov 2016) ISSN: 1365-2141 [Electronic] England
• PMID: 27790699 (Publication Type: Journal Article)
• Copyright: © 2016 John Wiley & Sons Ltd.

Chemical References

• Biomarkers

Topics

• Adolescent
• Adult
• Age Factors
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Biomarkers
• Female
• Humans
• Lymphoma, Large B-Cell, Diffuse (diagnosis, drug therapy, epidemiology, mortality)
• Male
• Middle Aged
• Neoplasm Staging
• Registries
• Risk Factors
• Survival Analysis
• Sweden (epidemiology)
• Treatment Outcome
• Young Adult