scholarly journals Racial Differences in Treatment Dose Intensity Among Patients with Diffuse Large B-Cell Lymphoma: Analysis of the Veterans Health Administration (VHA) National Database

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 554-554
Author(s):  
Peter A Riedell ◽  
Kristen M. Sanfilippo ◽  
Katiuscia O'Brian ◽  
Weijian Liu ◽  
Suhong Luo ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Multivariate Logistic Regression ◽  
Factors Associated ◽  
Large B Cell Lymphoma ◽  
Treatment Dose ◽  
To Receive

Abstract Introduction: Previous studies in diffuse large B-cell lymphoma (DLBCL) have demonstrated that higher treatment dose intensity is associated with improved survival. Race-based differences in dose intensity may contribute to outcome differences. In order to better understand the relationship between dose intensity and race, we performed a retrospective analysis of veterans examining demographic and clinical factors associated with dose intensity in patients with DLBCL. Methods: Patients diagnosed with DLBCL between October 1, 1998 and December 31, 2008 and treated within the VHA system with CHOP or CHOP-like regimens (+/- rituximab) were identified in the VA Central Cancer Registry. Data on age, sex, race, stage, lactate dehydrogenase (LDH), B-symptoms, body mass index, HIV status, co-morbidities, medications, and socioeconomic status were obtained. Average relative dose intensity (ARDI) was calculated for the use of cyclophosphamide and doxorubicin in patients who received CHOP chemotherapy. Univariate analysis was performed to explore demographic and clinical characteristics dichotomized by ARDI < or ≥ 80%. Additionally, a multivariate logistic regression analysis was used to identify baseline factors associated with receiving treatment with an ARDI ≥ 80%. Results: 1575 DLBCL patients who received doxorubicin and survived more than 5 months after treatment initiation were identified. On univariate analysis, patients who received ARDI <80% were more likely to be older (66.1 vs 61.2, p=<0.001), have advanced stage disease (58.9% vs 52.7%, p=0.015), have systemic B-symptoms (51.7% vs 45.5%, p=0.002), have more co-morbidities (mean co-morbidity score 2.4 vs 1.7, p=<0.0001), have HIV (7.5% vs 3.3%, p=0.0002), less likely to receive rituximab (73.5% vs 79.1%, p=0.008), and were more likely to be from the lowest estimated household income quartile (25.5% vs 21.8%, p=0.03). While not statistically significant on univariate analysis, patients receiving lower ARDI were slightly more likely to be Black (13.8% vs 10.6%, p=0.053). On multivariate logistic regression analysis, factors associated with reduced odds of receiving treatment with an ARDI ≥ 80% included: Black race, (OR 0.62; 95% CI 0.44 – 0.87), age (OR 0.96; 95% CI 0.95 – 0.97), HIV positive status (OR 0.24; 95% CI 0.14 – 0.40), and presence of B-symptoms (OR 0.74; 95% CI 0.59 – 0.93). Conclusion: After controlling for the other identified variables, Black patients were significantly less likely to receive an ARDI of ≥ 80%. The reasons for this finding are unknown from this analysis. Future efforts to reduce racial outcome disparities in NHL could include efforts to understand the underlying causes of chemotherapy dose reductions and delays in racial minority populations, which were present in the VHA, an equal access healthcare system. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic Significance of Pretreatment Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio in Patients with Diffuse Large B-Cell Lymphoma

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Siqian Wang ◽  
Yongyong Ma ◽  
Lan Sun ◽  
Yifen Shi ◽  
Songfu Jiang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
B Cell ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
B Cell Lymphoma ◽  
Cox Regression Analysis ◽  
Lymphocyte Ratio ◽  
Large B Cell Lymphoma ◽  
Large B Cell

It is generally believed that there is correlation between cancer prognosis and pretreatment PLR and NLR. However, there are limited data about their role in diffuse large B cell lymphoma (DLBCL). This study aims to determine the prognostic value of pretreatment PLR and NLR for patients who have DLBCL. The associations between clinical characteristics and NLR and PLR were evaluated among 182 DLBCL patients from January 2005 to June 2016. The optimal cutoff values for high PLR (⩾150) and NLR (⩾2.32) in prognosis prediction were determined. The effect of NLR and PLR on survival was evaluated through multivariate Cox regression analysis, univariate analysis, and log-rank test. According to the evaluation results, patients with high NLR and PLR had significantly shorter OS (P=0.026 and P=0.035) and PFS (P=0.024 and P=0.022) compared with those who have low PLR and NLR. On multivariate analyses, IPI>2, elevated LDH, and PLR⩾2.32 were prognostic factors for OS and PFS in DLBCL patients. Therefore, we demonstrated that high PLR and NLR predicted adverse prognostic factors in DLBCL patients.

The impacts of initial and relative dose intensity of R-CHOP on outcomes of elderly patients with diffuse large B-cell lymphoma

2016 ◽  
Vol 58 (3) ◽  
pp. 736-739 ◽  
Author(s):  
Yusuke Kanemasa ◽  
Tatsu Shimoyama ◽  
Yuki Sasaki ◽  
Miho Tamura ◽  
Takeshi Sawada ◽  
...  
Keyword(s):  
Elderly Patients ◽  
B Cell ◽  
Cell Lymphoma ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Relative Dose Intensity ◽  
Large B Cell Lymphoma ◽  
Large B Cell

The Impact of Relative Dose Intensity (RDI) of CHOP on Outcome of Diffuse Large B-Cell Lymphoma: Results of a Single Center Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4456-4456
Author(s):  
Yoshiki Terada ◽  
Hirohisa Nakamae ◽  
Takahiko Nakane ◽  
Hideo Koh ◽  
Yasunobu Takeoka ◽  
...  
Keyword(s):  
B Cell ◽  
Clinical Outcomes ◽  
Cell Lymphoma ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Relative Dose Intensity ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Large B Cell

Abstract Introduction: The achievement of a clinical response to the first induction chemotherapy has been considered for predicting survival in patients (pts) with aggressive non-Hodgkin lymphoma (NHL). Reduced dose intensity of chemotherapy has been likely to compromise long-term outcome of the patients with aggressive NHL treated with a standard chemotherapy of cyclophosphamide (CY), doxorubicin (ADR), vincristine and prednisone (CHOP). In particular, recent studies have revealed the relevance of relative dose intensity (RDI) to clinical outcomes, with reduced RDI leading to a poor survival, as well as the impact of RDI<85% for aggressive NHL with detailed analysis of risk factors influencing reduce RDI<85% (Gary H. Lyman, J. Clin Oncol22: 4302, 2004). This study was conducted to investigate the impact of RDI<85% of CHOP on outcomes of the pts with diffuse large B-Cell lymphoma (DLCL). Methods: Data were retrospectively collected on 100 pts with DLCL who had been initially treated with more than 3 courses of CHOP (n=70) or CHOP plus rituximab (CHOP-R, n=30) at our institution between 1995 and 2006. We evaluated whether RDI might affect clinical outcomes, including complete response (CR) and event free survival (EFS). The average RDI derived from CY and ADR (referred to as RDI-CY/ADR) was determined for each patient, with classified into 2 populations according to the differences from the value of 85%, including RDI-CY/ADR<85% (n=60), and RDI-CY/ADR≥85% (n=40). Results: The median age of the study population was 54 years (range, 17 to 76), with 36 pts older than 60 years (yrs) of age. According to International Prognostic Index (IPI) score, pts were classified into 2 groups of low/ low-intermediate (n=46) and high/ high-intermediate (n=54). The overall CR rate reached 62%, and the probability of overall survival (OS) or EFS at 5 years estimated 77% or 43%, respectively with a median follow-up of 13.3 months. Multivariate analysis identified RDI-CY/ADR<85%, as well as IPI score to be associated with CR rate and EFS. Thus, RDI-CY/ADR<85% and IPI score of high/ high-intermediate were significant factors for lower CR rate (as RDI-CY/ADR≥85%, HR=0.3, 95% CI 0.1 to 0.7, p=0.009, and HR=5.5, 95% CI 2.2 to 14, p<0.001, respectively), and for reduced EFS (HR=1.9, 95% CI 1.0 to 3.7, p=0.048, and as IPI score of low/ low-intermediate HR=0.3, 95% CI 0.2 to 0.6, p<0.001, respectively). Furthermore, logrank analysis revealed that CY/ADR-RDI<85% was the significant factor for reduced EFS in non elderly pts (≤60 yrs of age), or in pts with IPI score of low/ low-intermediate (p=0.01, p=0.02, respectively). Conclusion: These data thus suggested the impact of RDI-CY/ADR<85% in influencing outcomes of the pts with DLCL, in terms of CR rate and EFS. Further investigation is currently planned to confirm this promising results with longer follow-up in larger numbers of pts with NHL.

The Impact of Relative Dose Intensity of Rituximab-CHOP on Survival in Diffuse Large B-Cell Lymphoma Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4931-4931
Author(s):  
Yoshiki Terada ◽  
Hirohisa Nakamae ◽  
Ran Moriguchi ◽  
Hiroshi Kanashima ◽  
Erina Sakamoto ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Dose Intensity ◽  
B Cell Lymphoma ◽  
Aggressive Lymphoma ◽  
Factors Influencing ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Large B Cell ◽  
Significant Factors

Abstract Background. Recently several retrospective studies showed that relative dose intensity (RDI) in combination chemotherapy including CHOP significantly influences survival in aggressive lymphoma. Based on these data, maintaining high RDI in chemotherapy by, for example, prophylactic granulocyte colony-stimulating factor (G-CSF) administration has been attempted to obtain better outcome. Moreover, rituximab, a chimeric monoclonal anti CD20 antibody combined with CHOP chemotherapy (R-CHOP) has significantly ameliorated the outcome in patients with diffuse large B-cell lymphoma (DLBL). However, it is unclear if higher RDI even in combination with rituximab will improve outcome in B cell type aggressive lymphoma. Hence, in the current study, we retrospectively analyzed the impact of RDI in R-CHOP as an initial treatment on survival of patients with DLBL. Furthermore, we determined the factors influencing RDI. Patients and Methods. We studied 100 previously untreated DLBL patients who underwent more than 3 courses of R-CHOP chemotherapies at 5 institutions from December 2003 to February 2008. The median age of the patients was 60 years old (range 19–79). The median number of R-CHOP course was 6 (range, 3–8). In the current study, the RDI was calculated by averaging the delivered RDIs of cyclophosphamide (CY) and adriamycin (ADR) for all chemotherapy courses. Results. The median average RDI of CY and ADR (CY/ADR-RDI) in all patients was 87.9%. Twenty three of 100 patients were treated with RDI less than 75 %. With a median follow-up of 21.2 months, the probability of 4-year overall survival (OS) was significantly higher in patients with higher RDI (&gt;=75%) than that in patients with lower RDI (&lt;75%) (78.6 % vs. 60%; P = 0.01). In univariate Cox regression model to identify prognostic factors for OS, RDI [hazard ratio (HR) = 0.7 per 0.1 of RDI; 95% CI 0.6– 0.9; P = 0.02] and high/high-intermediate International Prognostic Index (IPI) (HR = 4.7; 95% CI 1.3–17; P = 0.04) were significant factors influencing OS. In multivariate model, RDI was only a significant factor influencing OS (HR = 0.8 per 0.1 of RDI; 95% CI 0.6–1.0; P = 0.04). In multivariate logistic analysis to determine factors influencing RDI, elderly patients (&gt;=51 ) [odds ratio (OR) = 0.2; 95% CI 0.1–0.7; P = 0.01] and high/high-intermediate IPI (OR = 0.3; 95% CI 0.1–1.0; P = 0.04) were significant factors for reduced RDI, whereas prophylactic G-CSF (OR = 3.2; 95% CI 1.1–9.3; P = 0.04) was found to be a significant factor for increased RDI. Conclusion. In newly diagnosed DLBL patients, the current results demonstrated that high RDI in CHOP even when combined with rituximab was significantly associated with better survival and higher RDI could be effectively maintained by G-CSF.

High Rate of Initial Treatment Failure in Patients with Primary Mediastinal B-Cell Lymphoma Treated with R-CHOP

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1601-1601 ◽  
Author(s):  
Jeremy S. Abramson ◽  
Matthew D Hellmann ◽  
Yang Feng ◽  
Jeffrey A. Barnes ◽  
Tak Takvorian ◽  
...  
Keyword(s):  
Risk Factors ◽  
B Cell ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Refractory Disease ◽  
Large B Cell Lymphoma ◽  
Ann Arbor ◽  
Large B Cell

Abstract Abstract 1601 Introduction: Primary Mediastinal B-cell Lymphoma (PMBCL) is an uncommon variant of Diffuse Large B-cell Lymphoma (DLBCL). Given the rarity of this disease, data guiding management is extrapolated from DLBCL trials, or from small retrospective analyses limited to PMBCL. Prospective evaluation of R-CHOP in the MiNT trial showed excellent results in PMBCL, but this trial was limited to young low risk patients. We present the largest retrospective series to date of R-CHOP for PMBCL in all risk groups. Methods: We identified cases of PMBCL at our institution using a comprehensive clinicopathologic database derived from tumor registry data. Natural language processing software was used to search pathology reports for terms of “mediastinal lymphoma,” “mediastinal large cell lymphoma,” “mediastinal large B-cell lymphoma,” as well as “lymphoma” in mediastinal biopsy specimens. Cases were included if they met clinicopathologic criteria for PMBCL, defined as a large B-cell lymphoma with typical features for PMBCL presenting with a dominant anterior mediastinal mass. All patients had to have been treated with R-CHOP. Progression-free survival (PFS) and overall survival (OS) are calculated by the Kaplan-Meier method and univariate analysis is performed to assess predictors of outcome. Results: Fifty-eight cases from 2000–2011 met inclusion criteria and are included in the analysis. The median age was 38 years (range 20–82) and 60% were male. Forty-four patients (76%) presented at limited Ann Arbor stage and 12 patients (21%) at advanced stage; presenting stage could not be discerned in 2 patients. Fifty-five percent of patients presented with mediastinal bulk ≥10cm in size; median size was 11cm (range 5–17cm). LDH was elevated at diagnosis in 60% of patients, normal in 21%, and unknown in 19%. By revised IPI score, 19% were low-risk (0 risk factors), 60% were intermediate risk (1–2 risk factors) and 12% were high-risk (≥3 risk factors). R-CHOP was given for a median of 6 cycles (range 1–8); 51 of 58 patients received 6 or 8 cycles. Among patients who achieved initial remission, 78% underwent consolidative radiotherapy and the remainder were observed after chemotherapy alone. The overall response rate was 81% (90%CI [71%–89%]) with 72% complete responses and 9% partial responses. Ten patients (17%) had primary refractory disease defined as progression on treatment or within 3 months of completion of therapy. Among 46 patients who achieved a response, 5 (11%) subsequently relapsed. Two patients, both elderly, died during treatment. Among the 10 patients with primary refractory disease, 6 have died from progressive lymphoma, 2 patients are alive with active disease undergoing salvage therapy, 1 is alive and free of disease greater than 8 years from diagnosis, and 1 was lost to follow-up. Among 5 patients with relapsed disease, 2 are alive without disease at last follow-up, while 3 have died of progressive lymphoma. Median follow-up for the entire series is 58 months. Five-year PFS is 68% (95% CI, 55% to 80%) and 5-year OS is 76% (95% CI, 65% to 88%). On univariate analysis, advanced Ann Arbor stage and high R-IPI score were associated with inferior PFS and OS. (p=0.006 and p<0.001, respectively for PFS, p=0.005 and p<0.001 for OS, log-rank test). Conclusion: PMBCL treated with R-CHOP carries an overall favorable prognosis, though primary refractory disease occurs in a significant number of patients, and is rarely curable with second line therapy. Advanced stage disease and high R-IPI scores are associated with inferior outcome. Novel treatment approaches warrant evaluation in high-risk patients. Disclosures: No relevant conflicts of interest to declare.

Diffuse Large B-Cell Lymphoma with Testicular Involvement: Outcome and Risk of CNS Relapse in the Rituximab Era

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 780-780 ◽  
Author(s):  
David Telio ◽  
Diego Villa ◽  
Tamara Shenkier ◽  
Laurie H. Sehn ◽  
Richard Klasa ◽  
...  
Keyword(s):  
Research Funding ◽  
Cell Lymphoma ◽  
Systemic Disease ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
Large B Cell Lymphoma ◽  
Cns Relapse ◽  
Stage Disease ◽  
Large B Cell

Abstract Abstract 780FN2 Background: Testicular involvement of diffuse large B-cell lymphoma (Te-DLBCL) is associated with a poor outcome and a high risk of central nervous system (CNS) relapse. Rituximab is now routinely used into the treatment of both limited (LIM) and advanced (ADV) stage disease but it is unclear if this can reduce the rate of CNS relapse given it's limited penetration of the blood brain barrier and frequent parenchymal relapses in Te-DLBCL. A recent phase II study by the IELSG using R-CHOP, contralateral testicular radiation (RT) and IT prophylaxis in LIM stage patients demonstrated improved survival rates and a lower rate of CNS relapse compared with historical series. Herein, we evaluated the impact of R-CHOP on the natural history in all patients with Te-DLBCL Methods: The Centre for Lymphoid Cancer Database was used to identify patients with Te-DLBCL who were treated with curative intent. LIM stage was defined as stage I/II without bulk (< 10 cm) or B symptoms and also included patients with discordant involvement of the bone marrow with a low grade lymphoma whose stage was otherwise limited stage, and ADV stage included all others. Results: 109 patients with Te-DLBCL treated between 1985–2011 were identified including 10 patients (11%) with discordant non-follicular low grade lymphoma in the bone marrow (9) or lymph node (1). Twenty-one patients were excluded: chemotherapy refusal (7), palliative (n=9), HIV + (2), peritesticular and not testicular involvement (2), clinical information N/A (1). Of the remaining 88 patients, 40 received CHOP-like chemotherapy and 48 received R-CHOP. The median age at diagnosis was 68 y (range 26–83 y) and half the patients had LIM stage disease. Most patients received either prophylactic contralateral testicular RT (59) or had bilateral orchiectomy (11) with few exceptions: refusal (3), PD or death on therapy (12), unknown (3). Five patients with CNS disease at presentation (R-CHOP n=4; CHOP n=1) also received HD methotrexate (HDMtx) and IT CHT. Only nine patients (7 ADV) received CNS prophylaxis (R-CHOP n=4; CHOP n=5) either IT (8) or IT + HDMtx (1) R-CHOP treated patients were more likely to have > 1 extranodal (EN) sites involved (p=0.030), and there was a trend to a greater proportion of patients with ADV disease (p=.087). With a median follow up of 60 mos, the 5 year TTP and OS for the CHOP and R-CHOP treated patients was similar (TTP 52% vs 67.5%, p=.181; OS 52.5% and 57%, p=0.262). However, an improved TTP (p=.025) and a trend to improved OS (p=.085) was observed in ADV stage patients but not LIM stage patients (TTP p=.617, OS p=.407) treated with R-CHOP. In univariate analysis, stage, EN sites > 1, IPI (0-2 v 3–5) and urinary tract (UT) involvement (kidney, adrenal or ureter) were prognostic for both TTP and OS. In multivariate analysis treatment with rituximab, > 1 EN sites and UT disease were prognostic for both TTP (rituximab p=.006, > 1 EN sites, p=.014, and a trend for UT disease p=.067) and OS (rituximab, p=.009, > 1 EN sites p=.025, UT disease p=.016) Excluding patients with CNS disease at diagnosis, there was no difference in the time to CNS relapse (TTCNS) in R-CHOP (5 y 27%) compared to CHOP treated patients (5 y 23%) (p=.789) in both LIM (5 y 16.5% vs 23.5%, p=.901) and ADV disease (5 y 27% vs 23%, p=0.386). In univariate analysis, the IPI, EN sites, PS and UT disease were associated with an increased risk of CNS relapse. In multivariate analysis, only UT disease (HR 9.18, p<.0001) was predictive of CNS relapse. CNS relapse in LIM patients (12) was typically late (≤ 2 years n=9), commonly parenchymal, (n=9 vs leptomeningeal (LM) n=2, both n=1) and usually in the absence of systemic disease (9). In contrast, CNS relapse in ADV patients (12) was usually early (< ∼ 1 year 10/12), preferentially involved the LM either alone (8) or in concert (3) with parenchymal lesions but also in the absence of systemic disease (10/12). Conclusion: Although survival has improved in Te-DLBCL patients since the introduction of rituximab, the benefit is likely primarily through systemic disease control as there remains an inherently high risk of CNS relapse. Patients with ADV stage disease and particularly with UT tract involvement, have frequent early leptomeningeal relapse and should be considered for up-front CNS treatment. Given the propensity for late parenchymal relapses in LIM stage patients, strategies to test agents with CNS penetration need further investigation. Disclosures: Villa: Roche: Research Funding. Shenkier:Roche: Research Funding. Sehn:Roche: Honoraria, Research Funding. Klasa:Roche: Research Funding. Gascoyne:Roche: Research Funding. Connors:Roche: Research Funding. Savage:Roche: Honoraria, Research Funding.

R-CHOP21 Vs R-CHOP14 in 950 Diffuse Large B-Cell Lymphoma Patients: Results of a Multicentre Retrospective Study Form Italian Lymphoma Foundation (FIL)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1615-1615
Author(s):  
Luigi Rigacci ◽  
Benedetta Puccini ◽  
Maria Giuseppina Cabras ◽  
Luca Nassi ◽  
Alberto Fabbri ◽  
...  
Keyword(s):  
B Cell ◽  
Conflicts Of Interest ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Hematological Toxicity ◽  
Bulky Disease ◽  
Symptomatic Disease ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Abstract 1615 Background: Diffuse large B cell lymphoma (DLBCL) is one of the most common types of non-Hodgkin's lymphoma. R-CHOP21 (C21) is considered the standard therapy but a large number of studies have tested R-CHOP14 (C14). Aims: The aim of our study was to evaluate retrospectively a cohort of patients (pts) treated with C21 or C14 and to compare the efficacy of the therapy. Methods: All pts with diagnosis of DLBCL or follicular grade IIIb lymphoma, treated with curative intent in 9 Italian Hematological Centers, were accrued. All patients treated with C14 used G-CSF as primary prophilaxis, and only elderly (over 70 years) patients treated with C21 used G-CSF as primary prophilaxis. Results: From january 2002 to june 2011, 950 pts were accrued, 643 pts were treated with C21 and 307 were treated with C14. The median age was 63 (range 19–89). The two cohorts of pts were balanced for all clinical characteristics a part for age (<60 or >60 years) with more aged pts in C21 arm (p 0.001), bone marrow positivity and more than 3 lymph node stations involved that were higher in C14 arm (p: 0.05 and p: 0.001). After induction therapy 751 pts (79%) obtained a complete remission: 501/643 (78%) after C21 and 250/307 (81%) after C14. The remaining pts obtained partial response in 110 and 48 or no response in 32 and 9 respectively for C21 and C14. After a median period of observation of 38 months 104 pts relapsed (14%), 68 (65%) in the C21 arm and 36 (35%) in the C14 arm. After a median observation period of 3 years, considering the two therapies, C21 vs C14, no differences were reported in OS (Figure 1), PFS (Figure 2) and DFS: 80% vs 84%, 69% vs 71% and 54% vs 56% respectively. In univariate analysis OS was lower in older pts (azard ratio (ar): 2.57), IPI 2 (ar: 2.09), IPI 3 (ar: 4.36), IPI 4–5 (ar: 6.36), bulky disease (ar: 1.70), symptomatic disease (ar: 2.23). In multivariate analysis factors which mantained significantly worst prognosis were older age (ar: 1.35), IPI 2 (ar: 1.95), IPI 3 (ar: 3.76), IPI 4–5 (ar: 5.01) and bulky disease (ar: 1.43). As expected hematological grade III/IV toxicity was more frequent in pts treated with C14. No differences in extra-hematological toxicity were observed. Secondary malignancies were reported: 7 in C21 and 3 in C14. After 3 years of median observation 188 pts are dead: 137 (73%) in C21 and 51 (27%) in C14 (not statistically significant, p:0.08). The large majority of pts are dead for disease progression or relapse. Conclusions: In conclusion our results confirm that C14 do not improve the results of the standard C21 in the whole lymphoma population. Dose dense therapy did not affect OS or PFS also analysing sub group of pts. As expected a higher frequency of neutropenia was observed in C21 arm but did not translate in increasing infection rate. Further prospective randomized studies are needed to verify this preliminary observations. Disclosures: No relevant conflicts of interest to declare.

Prognostic Value of High Thymidine Kinase Activity in Previously Untreated Diffuse Large B-Cell Lymphoma Treated by R-CHOP

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1541-1541
Author(s):  
Kazuhito Suzuki ◽  
Yasuhito Terui ◽  
Noriko Nishimura ◽  
Yuko Mishima ◽  
Sakura Sakajiri ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Chi Square ◽  
Exact Test ◽  
Large B Cell Lymphoma ◽  
Chi Square Test ◽  
Activity Groups ◽  
Large B Cell

Abstract Abstract 1541 Introduction Thymidine kinase (TK) activity has been investigated as a prognostic factor in hematological malignancies, and several studies have demonstrated that a high TK activity correlates with the disease stage and provides prognostic information on overall survival (OS) and progression free survival (PFS). However, the prognostic significance of TK activity for patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP has not been investigated yet. The purpose of this retrospective study was to investigate the prognostic value of high TK activity compared with other laboratory findings in evaluating OS in patients undergoing R-CHOP for previously untreated DLBCL. Methods We retrospectively analyzed patients treated with R-CHOP for previously untreated DLBCL from September 2003 to October 2008 in our institute. We evaluated serum TK activity, C-reactive protein (CRP), lactate dehydrogenase (LDH), and hemoglobin (Hb) before R-CHOP. The cut-off for TK activity was defined as 14 IU/L. The cut-offs for CRP and LDH were defined as the upper normal limits, and the cut-off for Hb was defined as the lower normal limit. The primary endpoint was OS. The OS and PFS were analyzed by the Kaplan-Meier method, and biological prognostic factors for OS were evaluated by Cox regression analysis. Second, complete response (CR) rate was assessed by the chi square test and Fisher's exact test, comparing patients with and without the prognostic factors. All p-values reported were two-sided, and statistical significance was defined as p < 0.05. Results The clinical records of 242 patients with previously untreated DLBCL were analyzed in this study. The median age of the patients was 65.2 years old (range, 23.2 – 88.1). The median levels of TK activity, CRP, LDH, and Hb were 14.0 IU/L (range, 3.0 – 1100), 0.3 IU/L (range, 0.1 – 21.2), 254.5 IU/L (range, 111.0 – 44432), and 13.1 g/dL (range, 7.7 – 17.0), respectively. Median follow-up time for all patients was 53.0 months. Median OS was 82.3 months (95% CI, 78.6 – 86.0). The OS was significantly worse in patients with high TK activity (p =.001) and anemia (p =.006) by univariate analysis. Median OS in the high and low TK activity groups was 71.7 months (95% CI 63.9 – 79.4) and 85.9 months (95% CI 81.8 – 89.9). In multivariate analysis, the OS was significantly worse in patients with high TK activity (HR 2.640, 95% CI 1.018 – 6.881; p =.046) and anemia (HR 2.228, 95% CI 1.000 – 4.967; p =.050). Median PFS was 73.9 months (95% CI, 69.4 – 78.4). The PFS was significantly worse in patients with high TK activity (p =.000), anemia (p =.005), and high LDH level (p =.010) by univariate analysis. Median PFS in the high and low TK activity groups was 57.3 months (95% CI 48.7 – 66.0) and 80.9 months (95% CI 75.5 – 86.2). In multivariate analysis, PFS was significantly worse in patients with high TK activity (HR 2.809, 95% CI 1.375 – 5.737; p =.005) and anemia (HR 1.902, 95% CI 1.033 – 3.504; p =.039). The CR and overall response rates were 81.4% and 93.0%, respectively. The OS was significantly better in patients who achieved CR than those with partial response or less. Median OS in the CR and non-CR groups was 86.1 months (95% CI 82.7 – 89.5) and 66.0 months (95% CI 53.6 – 78.3), respectively (p <.001). According to the chi square test and Fisher's exact test, the CR rates of patients with high TK activity (p <.001), high CRP (p =.004), and high LDH (p =.019) were significantly worse. The CR rates in the high and low TK activity groups were 68.9% and 92.5%, respectively. The OS for patients with high TK activity who did not achieve CR was even significantly worse than that of both low TK activity patients who did not achieve CR and high TK activity patients who achieved CR (p =.047 and <.001). However, the OS was similar in high and low TK activity group patients who achieved CR (p =.171, Figure 1). Conclusion High TK activity significantly worsened OS and PFS among patients with previously untreated DLBCL who had undergone R-CHOP. While we commonly perform R-CHOP for DLBCL as an initial treatment, our findings show that the OS becomes significantly worse in patients who do not achieve CR by R-CHOP. The OS in patients with high TK activity who did not achieve CR was significantly worse than that with both low TK activity patients who did not achieve CR and high TK activity patients who achieved CR. Our findings suggest that novel treatment strategies for previously untreated DLBCL patients with high TK activity are certainly necessary. Disclosures: No relevant conflicts of interest to declare.

Glasgow Prognostic Score Is Superior to Other Inflammation-Based Scores in Predicting Survival of Diffuse Large B-Cell Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1454-1454
Author(s):  
Xiaoxiao Hao ◽  
Yongqiang Wei ◽  
Fen Huang ◽  
Xiaolei Wei ◽  
Yuankun Zhang ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Glasgow Prognostic Score ◽  
B Cell Lymphoma ◽  
Prognostic Scores ◽  
Lymphocyte Ratio ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Inflammation-based prognostic scores, such as the glasgow prognostic score (GPS), prognostic index(PI), prognostic nutritional index(PNI), neutrophil lymphocyte ratio(NLR), platelet lymphocyte ratio(PLR) was related to survival in many solid tumors. Recent study showed that GPS can be used to predict outcome in diffuse large B-cell lymphoma(DLBCL). However other inflammation related scores had not been reported in DLBCL, and it also remained unknown which of them was more useful to evaluate the survival in DLBCL. In this retrospective study, a number of 252 newly diagnosed and histologically proven DLBCL patients from January 2003 to December 2014 were included. An elevated GPS, PI, NLR, PNI and PLR were all associated with decreased overall survival(p=0.000, p=0.000, p=0.006, p=0.001 and p=0.001, respectively) and event-free survival (p=0.000, p=0.000, p=0.011, p=0.001 and p=0.009, respectively) in univariate analysis. Multivariate analysis indicated that GPS(RR=1.768, 95%CI=1.043-3.000, p =0.034) remained an independent prognostic predictor in DLBCL. The area under the curve of GPS (0.735, 95%CI=0.645-0.824) was greater than that of PI(0.710, 95%CI=0.621-0.799), PNI(0.600, 95%CI=0.517-0.683), NLR(0.572, 95%CI=0.503-0.642), and PLR(0.599, 95%CI=0.510-0.689) by Harrell's C-statistics. Especially in the DLBCL patients treated with R-CHOP, GPS also remained the most powerful inflammation-based prognostic score when comparing with PI, NLR, PNI and PLR (p=0.004, p=0.000, respectively for OS and EFS). In conclusion, these results indicate that Inflammation-based prognostic scores such as GPS, PI, NLR, PNI and PLR can be used to evaluate the outcome in DLBCL patients. Among them, GPS is the most powerful tool in predicting survival in DLBCL patients, even in the rituximab era. Disclosures No relevant conflicts of interest to declare.

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