Korean J Hematol.  2011 Jun;46(2):103-110. 10.5045/kjh.2011.46.2.103.

Addition of rituximab to the CHOP regimen has no benefit in patients with primary extranodal diffuse large B-cell lymphoma

• Jang G
• Yoon DH
• Kim S
• Lee DH
• Lee SW
• Huh J
• Suh C

• KMID: 1782774
• DOI: http://doi.org/10.5045/kjh.2011.46.2.103

Abstract

BACKGROUND
The addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy (R-CHOP) has significantly improved clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL). However, new predictors of patient response to R-CHOP have not been established. We aimed to evaluate the impact of R-CHOP compared with CHOP in patients with DLBCL and to establish clinical predictors of better outcomes in these patients.
METHODS
We retrospectively identified 177 patients diagnosed with CD20-positive DLBCL and treated with CHOP (N=82) or R-CHOP (N=95). The response rate, event-free survival (EFS), and overall survival (OS) rates were compared between the 2 treatment groups. All patients were classified into primary extranodal lymphoma (PENL) or nodal lymphoma (NL) subgroups, and the clinical parameters of each subgroup were analyzed.
RESULTS
The overall response rate was higher in R-CHOP group (95% vs. 84%, P=0.07). The 3-year EFS rate was significantly higher in R-CHOP group (71% vs. 52%, P=0.013), but the OS rate was comparable between the 2 groups (79% vs. 69%, P=0.23). A significant survival benefit was seen with R-CHOP compared to CHOP therapy in NL patients (P=0.002 for EFS and 0.04 for OS). Multivariate analyses confirmed that R-CHOP therapy is an independent prognostic factor for EFS (hazard ratio of 0.32 [0.17-0.62], P=0.001) and OS (hazard ratio of 0.4 [0.18-0.87], P=0.02) in NL patients.
CONCLUSION
Patients in the PENL group did not benefit from R-CHOP chemotherapy.

Keyword

CHOP; Diffuse large B-cell lymphoma; Rituximab; Primary extranodal lymphoma

MeSH Terms

Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols
B-Lymphocytes
Cyclophosphamide
Disease-Free Survival
Doxorubicin
Humans
Lymphoma
Lymphoma, B-Cell
Multivariate Analysis
Prednisolone
Prednisone
Retrospective Studies
Vincristine
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Combined Chemotherapy Protocols
Cyclophosphamide
Doxorubicin
Prednisolone
Prednisone
Vincristine

Figure

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  Fig. 1 Kaplan-Meier curves for (A) event-free survival and (B) overall survival in all 177 patients classified on the basis of the treatment regimen.

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  Fig. 2 Kaplan-Meier curves for (A) event-free survival and (B) overall survival in patients with nodal lymphoma; (C) event-free survival, and (D) overall survival in patients with primary extranodal lymphoma classified on the basis of the treatment regimen.

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  Fig. 3 Kaplan-Meier curves for (A) event-free survival and (B) overall survival in patients treated with R-CHOP classified on the basis of the redistributed International Prognostic Index score.

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