Serum Soluble Tumor Necrosis Factor Receptor 1 Level is Associated with the Outcome of Diffuse Large B-Cell Lymphoma Patients Treated with the CHOP or R-CHOP Regimen

Non-Hodgkin’s Lymphoma (NHL) rarely presents during pregnancy and primary mediastinal large B-cell lymphoma (PMLBCL) accounts for approximately 2.5% of patients with NHL. The case of a 22-year-old woman who was diagnosed with Stage IIA PMLBCL during week 13 of her intrauterine pregnancy is described. The staging consisted in computed tomography (CT) of the chest and magnetic resonance imaging (MRI) of the abdomen and pelvis. She was managed with R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for a total of six cycles and, because of the early presentation during the second trimester, she received the entire chemotherapy course during the pregnancy. She delivered a healthy baby at 34 weeks of pregnancy and a18FDG-PET/CT scan demonstrated complete remission after delivery. After 20 months of follow up she remains with no evidence of disease and her 1-year-old son has shown no developmental delays or physical abnormalities. PMLBCL, although an uncommon subgroup of DLBCL, may present during pregnancy and R-CHOP should be considered as one suitable option in this complex scenario.

Download Full-text

Addition of Rituximab to CHOP Regimen Improves Clinical Outcome in Non-Germinal Center Type Diffuse Large B-Cell Lymphoma.

Blood ◽

10.1182/blood.v108.11.4725.4725 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4725-4725

Author(s):

Masahiro Yokoyama ◽

Daisuke Ennishi ◽

Kyoko Ueda ◽

Makoto Kodaira ◽

Shuhei Yamada ◽

...

Keyword(s):

Clinical Outcome ◽

B Cell ◽

Germinal Center ◽

Cell Lymphoma ◽

Expression Patterns ◽

B Cell Lymphoma ◽

Chop Regimen ◽

Large B Cell Lymphoma ◽

Type 3 ◽

Large B Cell

Abstract Background: In recent years, diffuse large B-cell lymphoma (DLBCL) has been classified into the germinal center B-cell (GC) type, the activated B-cell (ABC) type, and the type 3 using global gene expression profiling or immunohistochemical staining. It has been reported that the GC type DLBCL showed significantly longer survival than the non-GC (ABC and the type 3) type DLBCL treated with CHOP or CHOP like regimen not using rituximab. Methods: We analyzed retrospectively the prognosis between the GC and non-GC types of DLBCL treated with R-CHOP regimen. All 50 patients with DLBCL, diagnosed between July 2003 and July 2005 were included in this study. The pathology was reviewed by hematopathologist and confirmed to be de novo DLBCL according to the WHO classification. Patients with primary CNS- and post-transplant lymphomas were excluded. GC type or non-GC type DLBCL was determined by immunohistochemistry such as the expression patterns of CD10, BCL-6, and IRF-4 (MUM1). All patients were initially treated with six cycles of R-CHOP regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. If we evaluated partial response after six cycles of R-CHOP, the patients have added radiation therapy. Results: The patients consisted of 30 GC type and 20 non-GC type DLBCL with a median age of 61.0 yr (range 31–83 yr). The median follow up of surviving patients was 24 months. CR rate between GC and non-GC types were 57.0% vs. 75.0%, p=0.186, and overall response rate were 87.0% vs. 90.0%, p=0.929, respectively. The median of progression free survival was 17.3 months vs. 19.6 months, p=0.80. There is no statistical significance difference between two groups. Conclusion: These results suggest that addition of rituximab to CHOP regimen improves clinical outcome of non-GC type DLBCL as well as GC type DLBCL.

Download Full-text

Weekly Four Times Rituximab Consolidation Following Reduced Cycles Of R-CHOP Induction Chemotherapy In Extremely Elderly Patients With Diffuse Large B Cell Lymphoma

Blood ◽

10.1182/blood.v122.21.3031.3031 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3031-3031

Author(s):

Deok-Hwan Yang ◽

Won Seog Kim ◽

Young-Rok Do ◽

Sung Yong Oh ◽

Min Kyoung Kim ◽

...

Keyword(s):

Partial Response ◽

Adverse Events ◽

Elderly Patients ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Concomitant Disease ◽

Chop Regimen ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Purpose Poor outcome of patients with elderly diffuse large B-cell lymphoma (DLBCL) has been linked to their decreased ability to receive full course of R-CHOP, dose-reduction of chemotherapy due to toxicities and their concomitant disease to interrupt the treatment. Recently, several studies suggested that attenuated R-CHOP regimen or reduced cycles of R-CHOP showed the survival benefit along with good tolerability and safety for very elderly patients. The study is aimed to determine objective response, toxicitiy and clinical outcome of weekly four times rituximab augmentation after reduced cycles of R-CHOP in extremely elderly patients with DLBCL. Patients and Methods Prospective, multi-institutional phase II trial was conducted for patients with previously untreated CD20+ diffuse large B cell lymphoma who aged more than 70 years and achieved complete or partial response after 4th R-CHOP chemotherapy (NCT01181999). R-CHOP was infused every 21 days, with initial dose-intensity of CHOP regimen was modulated according to Charlson Comorbidity Index (CCI). If patients were with CCI <1, patients were treated with standard dose of CHOP, however, if patients with CCI °Ã1, patients were with 75% of conventional dose initially. Rituximab consolidation (375mg/m2) was treated weekly four times, at the time of full recovery after 4th R-CHOP. Trimethoprim/sulfamethoxasole (160mg/800mg, 1T orally) was given daily during rituximab consolidation. Response assessment based on Revised International Workshop Criteria was evaluated at the completion of the fourth R-CHOP, after rituximab consolidation and whenever disease progression is suspected. Results 51 DLBCL patients were enrolled from 14 institutes between June 2010 and April 2013. Median age was 76 years (range: 70-89) and 35.3% patients had more than 2 concomitant chronic disease. 36 out of 51 patients could be proceeded toward weekly four times rituximab consolidation. High treatment-related mortality (13.7%) during R-CHOP was huddle to proceeding to consolidation treatment. 35 patients (68.6%) presented with high-intermediate or high risk based on IPI and 12 patients (23.5%) were classified with a score of 2 by Glasgow prognostic score (GPS). After a median follow-up of 18.6 months, overall response rate was 70.6% with 66.7% of complete response and 3.9% of partial response. 31 patients (60.8%) were started with decreased dose of CHOP with median 75% reduction of CHOP (range; 50-100%). 2-year probability of progression-free survival (PFS) was 71.5 ±7.9% with 10 relapses. GPS based on systemic inflammatory indicators was a useful prognostic indicator for PFS compared to IPI. The adverse events were mainly related with hematologic toxicities and neutropenic infections during R-CHOP. However, no toxicities were reported associated with rituximab weekly infusion and no adverse events related with delayed infection after rituximab consolidation. Conclusions Rituximab consolidation after reduced cycles of R-CHOP resulted in a favorable response with high tolerability. Debulking R-CHOP and followed by weekly rituximab consolidation could be a good compromise between efficacy and tolerability for extremely elderly DLBCL Disclosures: No relevant conflicts of interest to declare.

Download Full-text