Korean J Hematol.  2010 Dec;45(4):253-259. 10.5045/kjh.2010.45.4.253.

Additional rituximab-CHOP (R-CHOP) versus involved-field radiotherapy after a brief course of R-CHOP in limited, non-bulky diffuse large B-cell lymphoma: a retrospective analysis

Affiliations
  • 1Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea. jhagnes@gilhospital.com
  • 2Department of Therapeutic Radiology & Oncology, Gachon University Gil Hospital, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea.

Abstract

BACKGROUND
Standard treatment for stage I or non-bulky stage II diffuse large B-cell lymphoma (DLBCL) has been either a brief course of chemotherapy plus involved-field radiotherapy (IFRT) or prolonged cycles of chemotherapy. The introduction of rituximab has necessitated re-evaluation of the treatment for limited disease (LD) DLBCL.
METHODS
Thirty-nine LD DLBCL patients (median age, 52 years; range, 24-85) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) were retrospectively analyzed. Treatment outcomes were evaluated, and toxicity, event-free survival (EFS), and overall survival (OS) were compared according to the treatment and risk factors.
RESULTS
The median follow-up duration was 34.6 months (range, 9.1-65.4). The 3-year EFS and OS were 76.0% and 86.0%, respectively. Among the 36 patients who underwent either 3-4 cycles of R-CHOP followed by IFRT (N=22) or 6-8 cycles of R-CHOP (N=14), there was no difference in the 3-year EFS (79.4% vs. 71.6%, P=0.638) and 3-year OS (85.7% vs. 92.9%, P=0.732). Severe neutropenia and neutropenic fever were more frequent in patients treated with R-CHOP alone, with 1 treatment-related mortality. Among the IFRT patients, 1 required hospital admission for IFRT-related complications. No events or deaths were reported among patients without adverse risk factors.
CONCLUSION
The difference in outcomes between the 2 treatment options was not significant. Analysis of treatment outcomes suggested that baseline characteristics and expected toxicities should be considered in LD DLBCL treatment. Further studies are needed to define the optimal treatment in the rituximab era.

Keyword

Diffuse large B-cell lymphoma; Radiotherapy; Rituximab

MeSH Terms

Antibodies, Monoclonal, Murine-Derived
B-Lymphocytes
Cyclophosphamide
Disease-Free Survival
Doxorubicin
Fever
Follow-Up Studies
Humans
Lymphoma, B-Cell
Neutropenia
Prednisolone
Retrospective Studies
Vincristine
Rituximab
Antibodies, Monoclonal, Murine-Derived
Cyclophosphamide
Doxorubicin
Prednisolone
Vincristine

Figure

  • Fig. 1 Kaplan-Meier curves of (A) event-free survival and (B) overall survival in all 36 patients with stage I or non-bulky stage II diffuse large B-cell lymphoma.

  • Fig. 2 Kaplan-Meier survival analysis of (A) event-free survival and (B) overall survival according to treatment options.

  • Fig. 3 Kaplan-Meier estimates of (A) event-free survival and (B) overall survival according to adverse risk factors.


Cited by  2 articles

A therapeutic dilemma between the two "R"s: additional rituximab or radiotherapy for limited, non-bulky diffuse large B-cell lymphoma
Seok Jin Kim
Korean J Hematol. 2011;46(1):57-58.    doi: 10.5045/kjh.2011.46.1.57.

Abbreviated chemotherapy for limited-stage diffuse large B-cell lymphoma after complete resection
Jungmin Jo, Dok Hyun Yoon, Sang Wook Lee, Chan-Sik Park, Jooryung Huh, Kyoungmin Lee, Eun Hee Kang, Shin Kim, Cheolwon Suh
Blood Res. 2014;49(2):115-119.    doi: 10.5045/br.2014.49.2.115.


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