Limits...
Prognosis of patients with diffuse large B cell lymphoma not reaching complete response or relapsing after frontline chemotherapy or immunochemotherapy.

Rovira J, Valera A, Colomo L, Setoain X, Rodríguez S, Martínez-Trillos A, Giné E, Dlouhy I, Magnano L, Gaya A, Martínez D, Martínez A, Campo E, López-Guillermo A - Ann. Hematol. (2014)

Bottom Line: Rituximab did not modify these figures.In the relapse setting, 5-year survival from relapse was 25% for patients who never received rituximab, 54% for those who received rituximab only at relapse, and 48% for those treated with immunochemotherapy both as frontline and at relapse.New therapeutic approaches are needed in this group of patients.

View Article: PubMed Central - PubMed

Affiliation: Hematology Department, Hospital Clínic, IDIBAPS, C/. Villarroel, 170, 08036, Barcelona, Spain, jorovira@clinic.ub.es.

ABSTRACT
A retrospective study was performed to assess the outcome of patients with diffuse large B cell lymphoma (DLBCL) who did not achieve complete response or who relapsed before and after the use of rituximab. Clinical features and outcome of 816 (425 M/391 F; median age 63 years) patients diagnosed from 1991 to 2001 (pre-rituximab era, N = 348) and from 2002 to 2012 (rituximab era, N = 468) in a single institution were evaluated. Five hundred fifty-three patients achieved complete remission (CR), 57 partial response (PR), and 206 were refractory with a median overall survival of 15, 1.5, and 0.4 years, respectively. Patients receiving rituximab had lower risk of refractoriness or relapse. In primarily refractory and PR patients, there was not a difference in survival depending on whether patients received or not rituximab-containing frontline treatment. Early death rate was 11%, including 3.6% due to infectious complications. Rituximab did not modify these figures. In the relapse setting, 5-year survival from relapse was 25% for patients who never received rituximab, 54% for those who received rituximab only at relapse, and 48% for those treated with immunochemotherapy both as frontline and at relapse. In conclusion, relapsed/refractory patients with DLBCL show poor prognosis despite the use of frontline immunochemotherapy. New therapeutic approaches are needed in this group of patients.

Show MeSH

Related in: MedlinePlus

Outcome of the whole series of patients with diffuse large B cell lymphoma (a) and of those treated with curative intention (b). Overall survival (OS) and progression-free survival (PFS) of the subgroups (a1, b1). PFS according to the year of diagnosis (before and after December 2001) (a2, b2). OS according to the year of diagnosis (before and after December 2001) (a3, b3)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4374121&req=5

Fig1: Outcome of the whole series of patients with diffuse large B cell lymphoma (a) and of those treated with curative intention (b). Overall survival (OS) and progression-free survival (PFS) of the subgroups (a1, b1). PFS according to the year of diagnosis (before and after December 2001) (a2, b2). OS according to the year of diagnosis (before and after December 2001) (a3, b3)

Mentions: Median follow-up for surviving patients was 6.5 years (range 0.02–23.2). One hundred fifty out of 553 patients in CR eventually relapsed. Five-year PFS was 45.5 % (95 % CI 44.4–46.6 %), with significant differences between the pre-R and R period (5-year PFS 39 vs 51 %, respectively; P = 0.002) (Table 2). This difference was also observed in patients treated with curative intention (5-year PFS 45 vs 57 %, respectively; P = 0.002). Four hundred and nineteen patients died during the follow-up with a 5-year OS of 54 % (95 % CI 50.2–57.2 %), with a significant difference between pre-R and R eras (5-year OS 48 vs 59 %, respectively; P = 0.004). Once again, the difference was maintained in patients treated with curative intention (5-year OS 55 vs 65 %, respectively; P = 0.006). A multivariate analysis showed that in a model of 582 patients, IPI (P < 0.0001, HR 1.9, 95 % CI 1.7–2.3), use of rituximab (P < 0.0001, HR 0.5, 95 % CI 0.4–0.6) and bulky disease (P = 0.048, HR 1.3, 95 % CI 1.0–1.6) were the most important variables affecting OS. PFS and OS curves of the whole series and of those patients treated with curative intention are shown in Fig. 1. The cause of death was lymphoma in 83 % of cases which was similar in both groups. Twenty-seven second neoplasias (3.4 %) were detected during the follow-up with no significant differences between the two subgroups.Table 2


Prognosis of patients with diffuse large B cell lymphoma not reaching complete response or relapsing after frontline chemotherapy or immunochemotherapy.

Rovira J, Valera A, Colomo L, Setoain X, Rodríguez S, Martínez-Trillos A, Giné E, Dlouhy I, Magnano L, Gaya A, Martínez D, Martínez A, Campo E, López-Guillermo A - Ann. Hematol. (2014)

Outcome of the whole series of patients with diffuse large B cell lymphoma (a) and of those treated with curative intention (b). Overall survival (OS) and progression-free survival (PFS) of the subgroups (a1, b1). PFS according to the year of diagnosis (before and after December 2001) (a2, b2). OS according to the year of diagnosis (before and after December 2001) (a3, b3)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4374121&req=5

Fig1: Outcome of the whole series of patients with diffuse large B cell lymphoma (a) and of those treated with curative intention (b). Overall survival (OS) and progression-free survival (PFS) of the subgroups (a1, b1). PFS according to the year of diagnosis (before and after December 2001) (a2, b2). OS according to the year of diagnosis (before and after December 2001) (a3, b3)
Mentions: Median follow-up for surviving patients was 6.5 years (range 0.02–23.2). One hundred fifty out of 553 patients in CR eventually relapsed. Five-year PFS was 45.5 % (95 % CI 44.4–46.6 %), with significant differences between the pre-R and R period (5-year PFS 39 vs 51 %, respectively; P = 0.002) (Table 2). This difference was also observed in patients treated with curative intention (5-year PFS 45 vs 57 %, respectively; P = 0.002). Four hundred and nineteen patients died during the follow-up with a 5-year OS of 54 % (95 % CI 50.2–57.2 %), with a significant difference between pre-R and R eras (5-year OS 48 vs 59 %, respectively; P = 0.004). Once again, the difference was maintained in patients treated with curative intention (5-year OS 55 vs 65 %, respectively; P = 0.006). A multivariate analysis showed that in a model of 582 patients, IPI (P < 0.0001, HR 1.9, 95 % CI 1.7–2.3), use of rituximab (P < 0.0001, HR 0.5, 95 % CI 0.4–0.6) and bulky disease (P = 0.048, HR 1.3, 95 % CI 1.0–1.6) were the most important variables affecting OS. PFS and OS curves of the whole series and of those patients treated with curative intention are shown in Fig. 1. The cause of death was lymphoma in 83 % of cases which was similar in both groups. Twenty-seven second neoplasias (3.4 %) were detected during the follow-up with no significant differences between the two subgroups.Table 2

Bottom Line: Rituximab did not modify these figures.In the relapse setting, 5-year survival from relapse was 25% for patients who never received rituximab, 54% for those who received rituximab only at relapse, and 48% for those treated with immunochemotherapy both as frontline and at relapse.New therapeutic approaches are needed in this group of patients.

View Article: PubMed Central - PubMed

Affiliation: Hematology Department, Hospital Clínic, IDIBAPS, C/. Villarroel, 170, 08036, Barcelona, Spain, jorovira@clinic.ub.es.

ABSTRACT
A retrospective study was performed to assess the outcome of patients with diffuse large B cell lymphoma (DLBCL) who did not achieve complete response or who relapsed before and after the use of rituximab. Clinical features and outcome of 816 (425 M/391 F; median age 63 years) patients diagnosed from 1991 to 2001 (pre-rituximab era, N = 348) and from 2002 to 2012 (rituximab era, N = 468) in a single institution were evaluated. Five hundred fifty-three patients achieved complete remission (CR), 57 partial response (PR), and 206 were refractory with a median overall survival of 15, 1.5, and 0.4 years, respectively. Patients receiving rituximab had lower risk of refractoriness or relapse. In primarily refractory and PR patients, there was not a difference in survival depending on whether patients received or not rituximab-containing frontline treatment. Early death rate was 11%, including 3.6% due to infectious complications. Rituximab did not modify these figures. In the relapse setting, 5-year survival from relapse was 25% for patients who never received rituximab, 54% for those who received rituximab only at relapse, and 48% for those treated with immunochemotherapy both as frontline and at relapse. In conclusion, relapsed/refractory patients with DLBCL show poor prognosis despite the use of frontline immunochemotherapy. New therapeutic approaches are needed in this group of patients.

Show MeSH
Related in: MedlinePlus