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Published on: March 30, 2014
Diffuse Large B-Cell Lymphoma Treated With R-CHOP in a Resource-Limited Setting in South Africa: A Real-World Study
Zola Musimar1, Mtonga Mpetani1, Jeremy S Abramson2
1Radiation Oncology Department, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, Republic of South Africa.
Insights
Rituximab with chemotherapy (R-CHOP) shows good outcomes for diffuse large B-cell lymphoma (DLBCL) patients, even in resource-limited settings. Performance status is a key factor influencing survival in HIV-negative individuals.
Area of Science:
- Oncology
- Hematology
- Clinical Research
Background:
- Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma globally, with high incidence in HIV-prevalent regions.
- Rituximab-CHOP (R-CHOP) is the standard treatment, but rituximab accessibility is a challenge in developing nations.
Purpose of the Study:
- To evaluate the feasibility and outcomes of R-CHOP for HIV-negative DLBCL patients in a resource-limited setting.
- To identify prognostic factors affecting survival in this patient cohort.
Main Methods:
- Retrospective cohort study of HIV-negative DLBCL patients treated with R-CHOP from 2012-2017.
- Collection of clinical and demographic data to analyze survival outcomes.
Main Results:
- 73 patients were included; median age 55, 60.3% female, 53.5% with stage III/IV disease.
- 3- and 5-year progression-free survival: 75% and 69%; 3- and 5-year overall survival: 77% and 74%.
- Overall survival was significantly impacted by performance status (P=.04) and response to R-CHOP (P=.005), but not IPI or age.
Conclusions:
- R-CHOP treatment is feasible and yields good outcomes for DLBCL in resource-limited settings.
- Poor performance status emerged as the primary adverse prognostic factor for HIV-negative patients.
Background:
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma worldwide and particularly in Africa, where the incidence of HIV is the highest in the world. R-CHOP is the standard of care regimen for DLBCL, but access to rituximab is limited in developing countries.
Methods:
This is a retrospective cohort study that included all HIV-negative patients with DLBCL who received R-CHOP at a single institution from January 2012 to December 2017. Clinical and demographic data were collected to assess factors that influenced survival.
Results:
Seventy-three patients were included. Median age was 55 (17-76), 67.1% of patients were younger than 60 years, and 60.3% were female. Most presented with stages III/IV disease (53.5%) but with good performance status (56.% PS 0 and 1). Progression-free survival at 3 and 5 years was 75% and 69%, and overall survival at 3 and 5 years was 77% and 74%, respectively. Median survival had not been reached with a median follow-up of 3.5 years(0.13-7.9). Overall survival was significantly affected by performance status (P = .04), but not by IPI or age. Survival was significantly associated with response to chemotherapy after 4-5 cycles of R-CHOP (P = 0.005).
Conclusions:
Treatment of DLBCL with R-CHOP is feasible and can achieve good outcomes in resource-limited settings with rituximab-based chemotherapy. Poor performance status was the most important adverse prognostic factor in this cohort of HIV-negative patients.
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