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

Survival from relapse according to rituximab treatment at diagnosis or relapse. CT → R-CT chemotherapy at diagnosis and immunochemotherapy at relapse; R-CT → R-CT immunochemotherapy both at diagnosis and at relapse; CT → CT chemotherapy both at diagnosis and at relapse; a all cohort; b only patients treated with curative intention at relapse
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4374121&req=5

Fig5: Survival from relapse according to rituximab treatment at diagnosis or relapse. CT → R-CT chemotherapy at diagnosis and immunochemotherapy at relapse; R-CT → R-CT immunochemotherapy both at diagnosis and at relapse; CT → CT chemotherapy both at diagnosis and at relapse; a all cohort; b only patients treated with curative intention at relapse

Mentions: CR rates after salvage therapy were 42 versus 39 % in the pre-R and R era, respectively. In those patients treated with curative intention, CR rates were 51 versus 59 % (Table 3). Median survival from relapse (SFR) was 1.12 years, with a 29 % pre-R versus 28 % R 5-year SFR in pre-R and R eras (Fig. 4a). Median SFR of patients treated with curative intention was 2 years, whereas 5-year SFR was 33 versus 42 % in the pre-R and R eras, respectively (Fig. 4b). Variables at relapse predicting shorter SFR were older age (5-year SFR of 39 versus 22 % for patients <60 and ≥60 years, respectively, P = 0.04) and CNS relapse (5-year SFR of 37 and 18 % patients with or without CNS involvement, respectively, P = 0.02). A trend to shorter SFR was observed in those patients relapsing during the first 2 years after CR achievement (5-year SFR of 20 versus 46 % for patients relapsing ≤2 years or later, P = 0.07). SFR is shown in Fig. 5 according to the use of rituximab in front line and at relapse. Five-year SFR was 25, 54, and 48 % for patients who never received rituximab, those who received the drug only at relapse and those treated with rituximab both in front line and rescue regimen, respectively (P = 0.007). Such differences were maintained in patients treated with curative intention (Fig. 5b). A multivariate analysis showed that in a model of 69 patients, age at relapse >70 years (P = 0.023, HR 2.1, 95 % CI 1.1–3.9) and CNS involvement (P = 0.04, HR 2.1, 95 % CI 1.0–4.4) were the most important variables to predict SFR.Fig. 4


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 relapse according to rituximab treatment at diagnosis or relapse. CT → R-CT chemotherapy at diagnosis and immunochemotherapy at relapse; R-CT → R-CT immunochemotherapy both at diagnosis and at relapse; CT → CT chemotherapy both at diagnosis and at relapse; a all cohort; b only patients treated with curative intention at relapse
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig5: Survival from relapse according to rituximab treatment at diagnosis or relapse. CT → R-CT chemotherapy at diagnosis and immunochemotherapy at relapse; R-CT → R-CT immunochemotherapy both at diagnosis and at relapse; CT → CT chemotherapy both at diagnosis and at relapse; a all cohort; b only patients treated with curative intention at relapse
Mentions: CR rates after salvage therapy were 42 versus 39 % in the pre-R and R era, respectively. In those patients treated with curative intention, CR rates were 51 versus 59 % (Table 3). Median survival from relapse (SFR) was 1.12 years, with a 29 % pre-R versus 28 % R 5-year SFR in pre-R and R eras (Fig. 4a). Median SFR of patients treated with curative intention was 2 years, whereas 5-year SFR was 33 versus 42 % in the pre-R and R eras, respectively (Fig. 4b). Variables at relapse predicting shorter SFR were older age (5-year SFR of 39 versus 22 % for patients <60 and ≥60 years, respectively, P = 0.04) and CNS relapse (5-year SFR of 37 and 18 % patients with or without CNS involvement, respectively, P = 0.02). A trend to shorter SFR was observed in those patients relapsing during the first 2 years after CR achievement (5-year SFR of 20 versus 46 % for patients relapsing ≤2 years or later, P = 0.07). SFR is shown in Fig. 5 according to the use of rituximab in front line and at relapse. Five-year SFR was 25, 54, and 48 % for patients who never received rituximab, those who received the drug only at relapse and those treated with rituximab both in front line and rescue regimen, respectively (P = 0.007). Such differences were maintained in patients treated with curative intention (Fig. 5b). A multivariate analysis showed that in a model of 69 patients, age at relapse >70 years (P = 0.023, HR 2.1, 95 % CI 1.1–3.9) and CNS involvement (P = 0.04, HR 2.1, 95 % CI 1.0–4.4) were the most important variables to predict SFR.Fig. 4

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