scholarly journals A multi-institutional and case-matched control study on treatment outcomes of consolidative radiotherapy after a full course of R-CHOP compared with R-CHOP alone in Stage I–II diffuse large B-cell lymphoma (KROG 17-02)

2019 ◽  
Vol 60 (5) ◽  
pp. 677-684
Author(s):  
Mi Joo Chung ◽  
Won Kyung Cho ◽  
Dongryul Oh ◽  
Keun-Yong Eom ◽  
Jin Hee Kim ◽  
...  
Keyword(s):  
B Cell ◽  
Treatment Outcomes ◽  
Tumor Size ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Chop Chemotherapy ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Large B Cell

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.

Benefit of Consolidative Radiation Therapy in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP Chemotherapy

2010 ◽  
Vol 28 (27) ◽  
pp. 4170-4176 ◽  
Author(s):  
Jack Phan ◽  
Ali Mazloom ◽  
L. Jeffrey Medeiros ◽  
Tony G. Zreik ◽  
Christine Wogan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Stage I ◽  
Disease Stage ◽  
Chop Chemotherapy ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Purpose The current standard therapy for patients with diffuse large B-cell lymphoma (DLBCL) is rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The role of consolidative radiation therapy (RT) in the setting of R-CHOP chemotherapy is not well reported. This retrospective analysis is an attempt to clarify this role. Patients and Methods Subjects were 469 patients with histologically confirmed DLBCL treated between January 2001 and December 2007. Variables including age, sex, Ann Arbor disease stage, bulky disease status, standardized uptake values (SUVs) on positron emission tomography (PET), International Prognostic Index (IPI), and Ki67 staining (proliferation). Results Of 469 patients, 190 (40.5%) had stage I or II disease and 279 (59.5%) had stage III or IV disease, 327 (70%) had at least six cycles of R-CHOP, and 142 (30.2%) had involved-field RT (dose, 30 to 39.6 Gy) after complete response to chemotherapy. Median follow-up was 36 months (range, 8 to 85 months). Multivariate analysis showed that RT (P < .0001), IPI score (P = .001), response to therapy (P = .001), use of six to eight cycles of R-CHOP (P < .001), and combined presence (P = .006) or absence (P = .025) of high Ki67, high PET SUV, and bulky disease influenced overall survival (OS) and progression-free survival (PFS). Matched-pair analyses of patients who received six to eight cycles of R-CHOP with stage I or II disease (44 pairs) and all stages (74 pairs) indicated that RT improved OS (hazard ratio [HR], 0.52 and 0.29, respectively) and PFS (HR, 0.45 and 0.24, respectively) compared with no RT. Conclusion This study showed significant improvements in OS and PFS among patients who received consolidation RT after R-CHOP chemotherapy for DLBCL.

Phase II Trial of 90y-Ibritumomab Tiuxetan Treatment as Consolidation After 6th R-CHOP Chemotherapy in Patients with Limited-Stage, Bulky Diffuse Large B Cell Lymphoma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3751-3751 ◽  
Author(s):  
Deok-Hwan Yang ◽  
Won Seog Kim ◽  
Cheolwon Suh ◽  
Jae-Yong Kwak ◽  
Joo-Sep Jung ◽  
...  
Keyword(s):  
B Cell ◽  
Phase Ii ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Chop Chemotherapy ◽  
Bulky Disease ◽  
Limited Stage ◽  
Large B Cell Lymphoma ◽  
Bulky Mass ◽  
Large B Cell

Abstract Abstract 3751 Poster Board III-687 Limited-stage non-Hodgkin's lymphomas with bulky mass are known to have a poor prognosis as like to those with advanced disease. There are very limited data to compare the results of chemotherapy alone with those of combined modality treatment. However, defining local failure at bulky sites as one component of relapse, radioimmuotherapy (RIT) appears to reduce failure rates at sites of bulky disease. We assessed the clinical efficacy and toxicity of 6th R-CHOP chemotherapy and followed by ibritumomab tuixetan (Zevalin¢ç) consolidation in patients with bulky diffuse large B cell lymphoma (DLBCL). Patients and Methods This prospective, multi-center phase II clinical trial included the patients following as: i) patients with newly diagnosed CD20+ DLBCL ii) patients with stage I/II and bulky disease defined by maximum diameter greater than 10 cm or any mediastinal mass exceeding 1/3 the maximum trans-thoracic diameter (more than 8 cm) iii) patients that achieved a complete (CR) or partial response (PR) after 6th R-CHOP chemotherapy iv) aged over 18 years and ECOG performance status 0-2. Conventional, single dose of ibritumomab tuixetan (0.4 mCi/kg) was administered after 6th R-CHOP. Clinical response was evaluated after completion of 3rd and 6th R-CHOP and at 8 and 20 weeks after RIT, and assessed according to revised International Workshop Criteria. Results Twenty patients were treated with ibritumomab tuixetan as consolidation. Median age was 45.5 years and median size of bulky mass was 10.0 × 6.6 at diagnosis. 5 patients (35%) presented with high-intermediate or high risk by IPI and 4 patients underwent debulking operation. After a median of 17.5 months follow-up, the overall response rate was 95%, with a 80% CR and 15% PR. Two patients with PR after R-CHOP chemotherapy improved to CR after consolidation. However, four patients (20%) experienced a relapse with one of them progressed within 1 month after RIT. 2-year probability of progression-free survival (PFS) was 78.9 ±9.1%. The adverse events were mainly hematologic toxicities (more than grade3); neutropenia (60%) and thrombocytopenia (35%). Only one patient experienced a febrile neutropenia. Conclusions Consolidation treatment with Ibritumomab tuixetan resulted in a favorable response with tolerable toxicity in patients with bulky DLBCL. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Impact of Genetic Polymorphism of Myeloid Differentiation Primary Response Gene 88, Enhancer of Zeste Homolog 2, and B-cell Lymphoma 2 like 11 in Patients with Diffuse Large B Cell Lymphoma Treated with Rituximab, Cyclophosphamide, Doxorubicin, Vincristin

2021 ◽  
Vol 9 (A) ◽  
pp. 98-105
Author(s):  
Hussam Zawam ◽  
Noha E. Ibrahim ◽  
Rasha Salama ◽  
Mai Samir ◽  
Walaa Abdelfattah ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Poor Response ◽  
Cell Of Origin ◽  
Bulky Disease ◽  
Large B Cell Lymphoma ◽  
Younger Age ◽  
Extranodal Disease ◽  
Large B Cell

BACKGROUND: Despite the growing landscape of genetic drivers in Diffuse Large B-cell Lymphoma, yet their clinical implication is still unclear and R-CHOP regimen remains a “one size fits all” therapy. We aimed in this study to examine the prevalence of EZH2, BCL211 and MYD 88 genetic polymorphisms in DLBCL patients and correlate the results with various clinical and survival outcomes. METHODS: Genotyping of MYD88 (rs387907272 T/C), EZH2 (rs3757441 C/T), and BCL2L11 (rs3789068 A/G) polymorphisms were conducted using real time polymerase chain reaction analysis in a total of 75 DLBCL patients. RESULTS: Most of our cases carried the wild TT genotype of MYD88 gene (64%), the mutant TT genotype of EZH2 gene (52%) and the wild AA genotype of BCL2L11 gene (48%). Regarding cell of origin, Germinal Centre (GC) phenotype was present in 56% of cases while 44% expressed the Post-GC (PGC) phenotype. Poor response outcome to first line R-CHOP was significantly correlated with the mutated CC genotype of MYD 88 (p=0.02), while better response to R-CHOP was significantly associated with younger age <50 years (p <0.0001), good PS (p=0.046), normal LDH level (p=0.003), earlier stage (p <0.0001), good IPI score (p=0.009), absence of extranodal disease (p <0.0001) and absence of bulky disease (p=0.004). The median PFS and the 2 year OS were significantly higher in younger age, earlier stage, good IPI score, absence of extranodal disease, absence of bulky disease and in GC phenotype. CONCLUSIONS: Our results emphasized that the mutated genotype of MYD 88 gene polymorphism is significantly associated with poor response to R-CHOP therapy.

Electronic FRAIL score as a predictor of treatment outcomes in older patients with diffuse large B-cell lymphoma

2021 ◽  
Author(s):  
Jesse Zhang ◽  
Patricia Disperati ◽  
Anna Elinder-Camburn ◽  
Eileen Merriman ◽  
Sophie Leitch ◽  
...  
Keyword(s):  
B Cell ◽  
Treatment Outcomes ◽  
Older Patients ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell
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