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Published on: January 9, 2019
Diffuse large B-cell lymphoma: An institutional analysis
Ajay Gogia1, Chandan K Das1, Lalit Kumar1
1Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.
Insights
This study found that adding rituximab to chemotherapy improved response rates and event-free survival for diffuse large B-cell lymphoma (DLBCL) patients. Rituximab-based regimens offer better outcomes regardless of the lymphoma
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Diffuse large B-cell lymphoma (DLBCL) is the most prevalent form of non-Hodgkin's lymphoma.
- Understanding DLBCL patient characteristics and treatment outcomes is crucial for improving patient care.
Purpose of the Study:
- To analyze clinicopathological features of DLBCL patients.
- To evaluate the impact of rituximab on treatment response and survival in DLBCL.
- To investigate the role of cell of origin in DLBCL treatment outcomes.
Main Methods:
- Retrospective analysis of 267 DLBCL patients treated between May 2013 and July 2015.
- Data collected included demographics, clinical presentation, histopathology, stage, International Prognostic Index (IPI), and treatment details.
- Cell of origin and treatment outcomes, including response rates and event-free survival (EFS), were assessed.
Main Results:
- The study included 267 patients with a median age of 49 years; 52% had early-stage disease.
- Germinal center B-cell (GCB) origin was observed in 55% and activated B-cell (ABC) in 45% of cases with available data.
- Overall response rate was 84%, with complete response (CR) of 70.5%. Rituximab plus CHOP (RCHOP) showed significantly higher CR rates (77%) than CHOP alone (61.5%). Two-year EFS was 70%, with RCHOP associated with better EFS.
Conclusions:
- Adding rituximab to CHOP chemotherapy significantly improved response rates and EFS in DLBCL patients.
- The benefit of rituximab was observed irrespective of the lymphoma's cell of origin.
- This study provides evidence for the efficacy of rituximab-based therapy in DLBCL from India.
Introduction:
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma. We conducted a retrospective study to analyze the clinicopathological characteristics, cell of origin, response to therapy, and the outcome of patients with DLBCL.
Materials And Methods:
This was a retrospective study which included all patients with DLBCL registered at our center, between May 1, 2013, and July 31, 2015. The data regarding demography, clinical presentation, histopathology, stage, prognostic index, treatment, and treatment-related outcome were collected from prospectively maintained clinical case records of the patients.
Results:
In the study, we included 267 patients. The median age is 49 (20-81) years with male: female ratio of 2:1. B symptoms were seen in 124 (45%) of patients. Early Stages (I and II) were seen in 130 (52%) patients, while advanced Stages (III and 1V) were seen in 119 (48%) patients. Bulky disease (>7.5 cm) was seen in 30% of cases, and bone marrow was involved in 12%. Extranodal involvement is present in 35% of cases. Cell of origin data was available in 160 (60%) of cases, of which 88 (55%) were germinal center and 72 (45%) were activated B cell in origin. The distribution according to the international prognostic index (IPI) was as follows: low risk 40%, intermediate risk 45%, and high risk in 15%. Rituximab was used in 45% of cases. The overall response rate was 84% with a complete response (CR) rate of 70.5%. The CR rates were better with RCHOP compared with CHOP (77% vs. 61.5%, P = 0.001) and good-risk IPI (83.3% vs. 65.2%, P < 0.001) compared with intermediate- and high-risk IPI. Median follow-up period was 24 months, and 2-year event-free survival (EFS) was 70%. The presence of B symptoms, high IPI, failure to attain CR, poor PS, and nonrituximab-based chemotherapy were significantly associated with lower EFS.
Conclusions:
This is the first study from India, which investigated the impact of chemotherapy with or without rituximab in context of cell of origin. Adding rituximab to CHOP showed better response rate and EFS irrespective of cell of origin.
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