The outcome of combined-modality treatments for stage I and II primary large B-cell lymphoma of the mediastinum

Abstract We compared treatment outcomes between rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy alone with R-CHOP followed by consolidative radiation therapy (RT) in diffuse large B-cell lymphoma (DLBCL). We analyzed 404 patients with Stage I–II DLBCL who received six to eight cycles of R-CHOP and achieved a good response after a full course of chemotherapy. Propensity-score matching was used to assess the role of consolidative RT. The R-CHOP alone group (n = 184) was matched in a 1:2 ratio with the R-CHOP plus RT group (n = 92). Twenty-four (13.0%) of 184 patients receiving R-CHOP alone and 8 (8.7%) of 92 patients receiving R-CHOP plus RT had bulky diseases (>7.5 cm). A Deauville score of 1–2 was achieved for 159 (86.4%) of 184 patients receiving R-CHOP alone and 84 (91.3%) of 92 patients receiving R-CHOP plus RT. After a median follow-up time of 42 months, the recurrence-free survival (RFS) rate (86.7% vs 93.0%, P = 0.464) and overall survival rate (88.3% vs 95.1%, P = 0.295) at 5 years did not differ significantly between the R-CHOP alone and R-CHOP plus RT arms. In the additional multivariate analyses, large tumor size (>7.5 cm) was significantly associated with decreased RFS (hazard ratio, 2.368 and confidence interval, 1.837–6.697; P = 0.048). Consolidative radiation was not a significant factor for RFS (P = 0.563). Tumor size was a significant factor for RFS in the rituximab era. The outcome of omitting consolidative RT for good responders after six to eight cycles of R-CHOP chemotherapy was acceptable in early-stage DLBCL without a bulky disease.

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Value of Surveillance Studies for Patients With Stage I to II Diffuse Large B-Cell Lymphoma in the Rituximab Era

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.01.039 ◽

2015 ◽

Vol 92 (1) ◽

pp. 99-106 ◽

Cited By ~ 11

Author(s):

Susan M. Hiniker ◽

Erqi L. Pollom ◽

Michael S. Khodadoust ◽

Margaret M. Kozak ◽

Guofan Xu ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Stage I ◽

Surveillance Studies ◽

Large B Cell Lymphoma ◽

Large B Cell

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Japanese multicenter phase II study of CHOP followed by radiotherapy (RT) in stage I-II1 diffuse large B-cell lymphoma (DLBCL) of the stomach

Journal of Clinical Oncology ◽

10.1200/jco.2004.22.14_suppl.6527 ◽

2004 ◽

Vol 22 (14_suppl) ◽

pp. 6527-6527

Author(s):

S. Ishikura ◽

K. Tobinai ◽

A. Ohtsu ◽

S. Nakamura ◽

T. Yoshino ◽

...

Keyword(s):

B Cell ◽

Phase Ii ◽

Phase Ii Study ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Stage I ◽

Large B Cell Lymphoma ◽

Multicenter Phase ◽

Large B Cell

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Lymphoma recurrence 5 years or more following diffuse large B-cell lymphoma: Clinical characteristics and outcome

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.8562 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 8562-8562

Author(s):

J. Larouche ◽

F. Berger ◽

C. Chassagne-Clement ◽

C. Sebban ◽

H. Ghesquieres ◽

...

Keyword(s):

B Cell ◽

Clinical Characteristics ◽

Cell Lymphoma ◽

Autologous Transplantation ◽

B Cell Lymphoma ◽

Stage I ◽

Late Relapse ◽

Extranodal Involvement ◽

Large B Cell Lymphoma ◽

Large B Cell

8562 Background: Diffuse large B-cell lymphoma (DLBCL) usually relapses early following treatment but some relapses happen 5 years or later. Few data exist regarding clinical characteristics and outcome of these patients (pts). Methods: We performed a retrospective analysis of all pts from two centers in Lyon/France between 1980–2003 who presented a biopsy proven relapse 5 years or later following diagnosis of DLBCL. All available biopsies were revised and immunohistochemistry (IHC) completed. Results: Among 1492 pts with DLBCL, 54 were eligible. Clinical characteristics at diagnosis were: median age 57 y; stage I-II 63% (34/54); IPI low/low intermediate 84% (41/49) and extranodal involvement (EN) 66% (35/53). IHC at diagnosis: CD20 100% (46/46), CD10 28% (10/36), bcl-6 53% (9/17), MUM1 48% (11/23), bcl-2 68% (19/28), germinal-center phenotype (GC) 57% (12/21) and non-GC 43% (9/21). 47/53 received CHOP/ACVBP-like regimens, 1 autologous transplantation (ASCT) and 1 rituximab. Median time from diagnosis to relapse was 7.4 years (5–20.5 years). 44 pts (81%) had DLBCL histology at time of relapse and 10 pts (19%) indolent histology. MUM1 expression at diagnosis was associated with DLBCL histology at relapse (p=0.037). Clinical characteristics at relapse were: median age 66 y; stage I-II 48% (26/54); 73% (31/43) with DLBCL at relapse had EN. 54% (15/28) with DLBCL at relapse had a GC phenotype and 46% (13/28) a non-GC phenotype. Treatment at relapse included rituximab in 21/54 and ASCT in 15/54 with 7 pts receiving both. Estimated 5-year event-free survival (EFS) and overall survival (OS) after relapse were 25% and 35% for all pts. Pts with DLBCL histology at relapse had an estimated 5-year EFS and OS of 18% and 28%. Pts with indolent histology had an estimated 5-year EFS and OS of 55% and 67%. Conclusions: Patients with DLBCL who present a late relapse usually had localized stage, favorable IPI and extranodal involvement at diagnosis. However, even if initial characteristics at time of first treatment were favorable, outcome of pts with DLBCL at time of relapse remains poor and aggressive treatment, such as ASCT, should be pursue whenever possible. Some patients relapsed with indolent histology and have a better outcome. No significant financial relationships to disclose.

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Value of surveillance studies for patients (pts) with stage I-II diffuse large B-cell lymphoma (DLBCL) in the rituximab (R) era.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.15_suppl.8544 ◽

2014 ◽

Vol 32 (15_suppl) ◽

pp. 8544-8544

Author(s):

Susan M. Hiniker ◽

Erqi L. Pollom ◽

Michael S. Khodadoust ◽

Margaret M. Kozak ◽

Ranjana H. Advani ◽

...

Keyword(s):

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Stage I ◽

Surveillance Studies ◽

Large B Cell Lymphoma ◽

Large B Cell

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Exploratory Study on the Relationship Between FcγRIIIa Gene Polymorphisms and the Efficacy and Toxicity of Rituximab in the Treatment of Stage I/II Diffuse Large B-Cell Lymphoma

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2019.2035 ◽

2019 ◽

Vol 9 (5) ◽

pp. 615-622

Author(s):

Zhijun Wuxiao ◽

Hua Wang ◽

Qunhao Su ◽

Haiyan Zhou ◽

Min Hu ◽

...

Keyword(s):

B Cell ◽

Gene Polymorphisms ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Stage I ◽

Term Survival ◽

Large B Cell Lymphoma ◽

Significant Difference ◽

The Relationship ◽

Large B Cell

Rituximab is an IgG1 monoclonal antibody approved for the treatment of diffuse large B-cell lymphoma (DLBCL); however, its efficacy is poor in some patients. Previous studies indicate that the difference in efficacy may be due to antibody-dependent cell-mediated cytotoxicity (ADCC). The effect of ADCC is closely related to Fcγ receptor IIIA (FcγRIIIa) receptor gene polymorphisms, but no study has investigated this gene in patients with DLBCL in China. In this study, we explored FcγRIIIa gene polymorphisms in patients with DLBCL in China and the ethnic differences in the FcγRIIIa gene. Moreover, we determined the relationship between FcγRIIIa gene polymorphisms and the effect and toxicity of rituximab treatment. Peripheral blood samples of 60 patients with newly diagnosed stage I/II DLBCL who received standard treatment with rituximab were collected, and DNA samples were extracted and normalized. Among the FcγRIIIa gene polymorphisms, there was a homozygous mutation, a heterozygous mutation, and a wild-type genotype at the site of 161514542 (rs396991). The proportion of these genotypes was significantly different from those found in previous studies for European and American populations and healthy Chinese populations. Moreover, we found that individuals with the homozygous (158-V/V) or heterozygous (V/F) mutation possessed better near-term effectiveness of the standard chemotherapeutic treatment, although there was no significant difference in long-term survival. However, patients with one of these genotypes usually suffer from a more severe hematological toxicity in response to the rituximab treatment. In conclusion, knowledge of a patient's FcγRIIIa gene polymorphism may be of value for the individualized treatment of DLBCL, which is worthy of follow-up research.

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