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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 patients in partial remission after frontline therapy diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment
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Fig3: Survival from salvage treatment of patients in partial remission after frontline therapy diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment

Mentions: Fifty-seven patients were in PR after induction therapy, 26/348 (7.5 %) treated with CT, and 31/468 (7 %) with R-CT. When restricted to curative treatment, the figures were 22/271 (8.1 %) and 29/397 (7.3 %). Fifteen of the 57 patients (6 pre-R; 9 R) received only palliative measures, whereas 42 (20 pre-R; 22 R) received ESHAP salvage therapy (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin). Only two patients in the pre-R era received rituximab as part of salvage therapy, whereas all the cases in the R era were treated with R-ESHAP. CR rates were 25 % (5 out of 20) and 50 % (11 out of 22) in the pre-R and R era, respectively (P = 0.09). ASCT was performed in four pre-R and nine R patients. Long survival was 11.5 % (N = 3) and 35 % (N = 11), respectively (P = 0.03). Overall, the median survival after salvage treatment was 1 year, with a 5-year survival from rescue therapy of 19 vs 32 % for patients in the pre-R and R eras (Fig. 3a). Regarding patients treated with curative intention, the 5-year survival after salvage treatment was 26 vs 38 % (Fig. 3b and Table 3). Among four patients who underwent ASCT in the pre-R era, two achieved CR and two died early after ASCT due to cardiogenic shock and infection. One patient in CR died shortly afterward of disease progression. In the R era, six out of nine patients achieved CR, three died of disease progression, and two relapsed and were treated with a reduced intensity Allo-SCT. One of them died due to infectious complication, and the other patient is alive after 10 years.Fig. 3


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 patients in partial remission after frontline therapy 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

Fig3: Survival from salvage treatment of patients in partial remission after frontline therapy diagnosed before or after December 2001. a All patients; b only patients with curative intention to salvage treatment
Mentions: Fifty-seven patients were in PR after induction therapy, 26/348 (7.5 %) treated with CT, and 31/468 (7 %) with R-CT. When restricted to curative treatment, the figures were 22/271 (8.1 %) and 29/397 (7.3 %). Fifteen of the 57 patients (6 pre-R; 9 R) received only palliative measures, whereas 42 (20 pre-R; 22 R) received ESHAP salvage therapy (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin). Only two patients in the pre-R era received rituximab as part of salvage therapy, whereas all the cases in the R era were treated with R-ESHAP. CR rates were 25 % (5 out of 20) and 50 % (11 out of 22) in the pre-R and R era, respectively (P = 0.09). ASCT was performed in four pre-R and nine R patients. Long survival was 11.5 % (N = 3) and 35 % (N = 11), respectively (P = 0.03). Overall, the median survival after salvage treatment was 1 year, with a 5-year survival from rescue therapy of 19 vs 32 % for patients in the pre-R and R eras (Fig. 3a). Regarding patients treated with curative intention, the 5-year survival after salvage treatment was 26 vs 38 % (Fig. 3b and Table 3). Among four patients who underwent ASCT in the pre-R era, two achieved CR and two died early after ASCT due to cardiogenic shock and infection. One patient in CR died shortly afterward of disease progression. In the R era, six out of nine patients achieved CR, three died of disease progression, and two relapsed and were treated with a reduced intensity Allo-SCT. One of them died due to infectious complication, and the other patient is alive after 10 years.Fig. 3

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