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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.

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Survival from salvage treatment of frontline chemorefractory patients diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment
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Fig2: Survival from salvage treatment of frontline chemorefractory patients diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment

Mentions: Ninety-two out of 206 patients (45 %) who did not reach a response died within 4 months from diagnosis, including 10 patients who were never treated. These early death rates in patients receiving CT or R-CT were 35/348 (10 %) versus 57/468 (12 %), respectively. Infectious complications were the ultimate cause of death in 30 cases (3.2 vs 4 % in pre-R and R era, respectively), irrespective of the possible response of the disease. One hundred fourteen patients surviving more than 4 months were primary refractory to treatment; the median OS of this group was 0.75 years (Fig. 2a). Sixty-one of these patients (31 pre-R; 30 R) received only palliative measures mainly due to age and/or poor ECOG performance status, and all of them died between 4 and 44 months from diagnosis. Salvage treatment was administered to 53 patients (34 and 19 in the pre-R and R era, respectively). In the pre-R era, only one patient achieved CR (3 %) and three PR (9 %) whereas in the R era, three patients achieved CR (16 %) and five PR (26 %) (P = 0.027). One patient in PR in the pre-R era received allogeneic stem cell transplantation (Allo-SCT). This patient died in CR at 7.2 years after transplant due to esophagus carcinoma. In the R era, three patients received an ASCT and one an Allo-SCT. The only patient in the pre-R era who achieved CR died due to a stroke 14 years from the assessment of response. Three patients in the R era were long survivors. Overall, the median survival after salvage therapy of those patients treated with curative intention was 0.46 years (0.39 years in pre-R era vs 0.64 years in R era; P = 0.044) (Fig. 2b). Responses and survival after salvage treatment are summarized in Table 3.Fig. 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)

Survival from salvage treatment of frontline chemorefractory patients diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Survival from salvage treatment of frontline chemorefractory patients diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment
Mentions: Ninety-two out of 206 patients (45 %) who did not reach a response died within 4 months from diagnosis, including 10 patients who were never treated. These early death rates in patients receiving CT or R-CT were 35/348 (10 %) versus 57/468 (12 %), respectively. Infectious complications were the ultimate cause of death in 30 cases (3.2 vs 4 % in pre-R and R era, respectively), irrespective of the possible response of the disease. One hundred fourteen patients surviving more than 4 months were primary refractory to treatment; the median OS of this group was 0.75 years (Fig. 2a). Sixty-one of these patients (31 pre-R; 30 R) received only palliative measures mainly due to age and/or poor ECOG performance status, and all of them died between 4 and 44 months from diagnosis. Salvage treatment was administered to 53 patients (34 and 19 in the pre-R and R era, respectively). In the pre-R era, only one patient achieved CR (3 %) and three PR (9 %) whereas in the R era, three patients achieved CR (16 %) and five PR (26 %) (P = 0.027). One patient in PR in the pre-R era received allogeneic stem cell transplantation (Allo-SCT). This patient died in CR at 7.2 years after transplant due to esophagus carcinoma. In the R era, three patients received an ASCT and one an Allo-SCT. The only patient in the pre-R era who achieved CR died due to a stroke 14 years from the assessment of response. Three patients in the R era were long survivors. Overall, the median survival after salvage therapy of those patients treated with curative intention was 0.46 years (0.39 years in pre-R era vs 0.64 years in R era; P = 0.044) (Fig. 2b). Responses and survival after salvage treatment are summarized in Table 3.Fig. 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