Annals of Hematology

, Volume 88, Issue 9, pp 863–869 | Cite as

Reassessment of the prognostic factors of international prognostic index (IPI) in the patients with diffuse large B-cell lymphoma in an era of R-CHOP in Chinese population

  • Shen Yang
  • Yao Yu
  • Li Jun-Min
  • Mi Jian-Qing
  • Chen Qiu-Sheng
  • Chen Yu
  • Zhao Wei-Li
  • You Jian-Hua
  • Zhao Hui-Jin
  • Wang Yan
  • Wang Li
  • Cheng Shu
  • Shen Zhi-Xiang
Original Article

Abstract

We performed this study to reassess the prognostic factors of diffuse large B-cell lymphoma (DLBCL) in the era of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Chinese population. One hundred and twenty-five consecutive patients with DLBCL were enrolled in this study from February 2000 to September 2006. They had received six courses of R-CHOP regimen consisting of rituximab 375 mg/m2, intravenously, D1; cyclophosphamide 750 mg/m2, bolus infusion, D2; doxorubicin 50 mg/m2, bolus infusion, D2; vincristine 1.4 mg/m2, bolus infusion, D2; and prednisone 60 mg, orally, D2-6. All the patients were evaluated and followed-up after the treatment. Eighty-six out of 125 enrolled patients (68.8%) achieved complete response (CR), 16 patients (12.8%) achieved partial response (PR), 11 patients (12.8%) achieved stable disease, and 12 patients (9.6%) experienced progressive disease (PD). In univariate analysis, IPI factors, except for age, was correlated with the treatment outcome of complete remission; however, only early clinical stages and absence of bulky disease was statistically significantly associated with the better CR rate. Lactate dehydrogenase (LDH), extranodal diseases, bulky disease, and obtaining CR after completion of four courses of treatment was correlated with TTF (P = 0.038, 0.044, 0.034, and 0.000, respectively); performance status, LDH level, number of extranodal diseases, and obtaining CR after completion four courses of treatment significantly influenced OS (P = 0.027, 0.000, 0.019, and 0.000, respectively); and presence of bulky disease and obtaining CR at the end of fourth cycle of treatment were significantly correlated with DFS in multivariate analysis (P = 0.006 and 0.001, respectively) in Cox regression. IPI is still important in predicting the prognosis in the R-CHOP era in DLBCL; however, obtaining CR after four cycles of R-CHOP and presence of bulky disease should be considered together.

Keywords

Lymphoma Diffuse Large B cell Complete response Bulky disease 

References

  1. 1.
    Coiffier B (1997) Non-Hodgkin′s lymphomas. In: Cavalli F, Hansen HH, Kaye SB (eds) Textbook of medical oncology. Martin Dunitz, London, pp 265–287Google Scholar
  2. 2.
    Chen Y, Du H, Hu WW et al (2004) Clinicopathologic analysis and classification of 365 cases of non-Hodgkin’ s lymphomas according to the new WHO criteria. Chinese J Diagn Pathol 11:304–307Google Scholar
  3. 3.
    Zhang YN, Zhou XG, Zhang SH et al (2005) Clinicopathologic study of 369 B-cell non-Hodgkin lymphoma cases, with reference to the 2001 World health organization classification of lymphoid neoplasms. Zhonghua Bing Li Xue Za Zhi 34(4):193–197PubMedGoogle Scholar
  4. 4.
    Chuang SS, Lin CN, Li CY (2000) Malignant lymphoma in southern Taiwan according to the revised European–American classification of lymphoid neoplasms. Cancer 89:1586–1592 doi: 10.1002/1097-0142(20001001)89:7<1586::AID-CNCR24>3.0.CO;2–1 PubMedCrossRefGoogle Scholar
  5. 5.
    Coiffier B, Lepage E, Briere J et al (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346:235–242 doi: 10.1056/NEJMoa011795 PubMedCrossRefGoogle Scholar
  6. 6.
    Pfreundschuh M, Trumper L, Osterborg A et al (2006) CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 7:379–391 doi: 10.1016/S1470-2045(06)70664-7 PubMedCrossRefGoogle Scholar
  7. 7.
    Pfreundschuh M, Kloess M, Zeynalova S et al (2006) Six vs. eight cycles of bi-weekly CHOP-14 with or without rituximab for elderly patients with diffuse large B-cell lymphoma (DLBCL): results of the completed RICOVER-60 trial of the German high-grade non-Hodgkin’s lymphoma study group (DSHNHL). Blood 10864a abstract 205Google Scholar
  8. 8.
    Sehn LH, Donaldson J, Chhanabhai M et al (2005) Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol 23(22):5027–5033 doi: 10.1200/JCO.2005.09.137 PubMedCrossRefGoogle Scholar
  9. 9.
    Coiffier B (2005) Treatment of diffuse large B-cell lymphoma. Curr Hematol Rep 4(1):7–14PubMedGoogle Scholar
  10. 10.
    Habermann TM, Weller EA, Morrison VA et al (2003) Phase III trial of rituximab-CHOP (R-CHOP) vs. CHOP with a second randomization to maintenance rituximab (MR) or observation in patients 60 years of age and older with diffuse large B-cell lymphoma (DLBCL). Blood 102:6aGoogle Scholar
  11. 11.
    Moore DF Jr, Cabanillas F (1998) Overview of prognostic factors in non-Hodgkin′s lymphoma. Oncology 12(10):17–24PubMedGoogle Scholar
  12. 12.
    A predictive model for aggressive non-Hodgkin′s lymphoma: the International Non-Hodgkin′s Lymphoma Prognostic Factors Project. N Engl J Med 329:987–994 doi: 10.1056/NEJM199309303291402
  13. 13.
    Jaffe ES, Harris NL, Stein H, Vordiman JW Pathology and genetics of tumours of haematopoietic and lymphoid tissues. World Health Organization Classification of Tumours. Lyon: IARC, 2001Google Scholar
  14. 14.
    Wilder RB, Rodriguez MA, Medeiros LJMD (2002) International prognostic index-based outcomes for diffuse large B-cell lymphomas. Cancer 94(12):3083–3088 doi: 10.1002/cncr.10583 PubMedCrossRefGoogle Scholar
  15. 15.
    Hochster HS, Weller E, Ryan T et al (2004) Results of E1496: A Phase III trial of CVP with or without maintenance rituximab in advanced indolent lymphoma (NHL). Proc Am Soc Clin Oncol 23:556Google Scholar
  16. 16.
    Czuczman MS, Fallon A, Mohr A et al (2002) Rituximab in combination with CHOP or fludarabine in low-grade lymphoma. Semin Oncol 29(1):36–40 doi: 10.1053/sonc.2002.30152 PubMedCrossRefGoogle Scholar
  17. 17.
    Sehn LH, Berry B, Chhanabhai M et al (2007) The revised international prognostic index (r-ipi) is a better predictor of outcome than the standard ipi for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 109(5):1857–1861 doi: 10.1182/blood-2006-08-038257 PubMedCrossRefGoogle Scholar
  18. 18.
    Good clinical practice for trials on medicinal products in the European community. Good Clin Pract J 1:SupplGoogle Scholar
  19. 19.
    Cheson BD, Horning SJ, Coiffier B et al (1999) NCI-sponsored international working group. Report of an international workshop to standardize response criteria for non-Hodgkin′s lymphomas. J Clin Oncol 17:1244PubMedGoogle Scholar
  20. 20.
    Chen Y, Du H, Hu WW et al (2004) Clinicopathologic analysis and classification of 365 cases of non-Hodgkin′ s lymphomas according to the new WHO criteria. Chinese J Diagn Pathol 11:304–307Google Scholar
  21. 21.
    Zhang YN, Zhou XG, Zhang SH et al (2005) Clinicopathologic study of 369 B-cell non-Hodgkin lymphoma cases, with reference to the 2001 world health organization classification of lymphoid neoplasms. Zhonghua Bing Li Xue Za Zhi 34(4):193–197PubMedGoogle Scholar
  22. 22.
    Xiao C, Su ZL, Wu QL et al (2005) Clinical and pathological reassessment of 493 cases of non-Hodgkin’s lymphomas according to current WHO classification of lymphoid neoplasms. Zhonghua Bing Li Xue Za Zhi 34(1):22–27PubMedGoogle Scholar
  23. 23.
    Yin HF, Li T, Li JX (2003) Retrospective analysis of 304 cases of malignant lymphomas in pathology: study and practice of the WHO classification of lymphoid neoplasms. Zhonghua Yi Xue Za Zhi 83(18):1556–1560PubMedGoogle Scholar
  24. 24.
    Zhang HY, Lin TY, Jiang WQ et al (2004) Clinical analysis of rituximab combined with chemotherapy in treating aggressive B-cell non-Hodgkin’s lymphoma. Chin J Cancer 23(12):1681–1686Google Scholar
  25. 25.
    Lin TY, Zhang HY, Huang Y et al (2005) Comparison between R-CHOP regimen and CHOP regimen in treating naive diffuse large B-cell lymphoma in China—a multi-center randomized trial. Ai Zheng 24(12):1421–1426PubMedGoogle Scholar
  26. 26.
    Philip T, Guglielmi C, Hagenbeek A et al (1995) Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. N Engl J Med 333:1540–1545 doi: 10.1056/NEJM199512073332305 PubMedCrossRefGoogle Scholar
  27. 27.
    Gianni AM, Bregni M, Siena S et al (1997) High-dose chemotherapy and autologous bone marrow transplantation compared with MACOP-B in aggressive B-cell lymphoma. N Engl J Med 336:1290–129 doi: 10.1056/NEJM199705013361804 PubMedCrossRefGoogle Scholar
  28. 28.
    Milpied N, Deconinck E, Gaillard F et al (2004) Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 350:1287–1295 doi: 10.1056/NEJMoa031770 PubMedCrossRefGoogle Scholar
  29. 29.
    Corradini P, Ladetto M, Zallio F, Astolfi M, Rizzo E, Sametti S et al (2004) Long-term follow-up of indolent lymphoma patients treated with high-dose sequential chemotherapy and autografting: evidence that durable molecular and clinical remission frequently can be attained only in follicular subtypes. J Clin Oncol 22:1460–1468 doi: 10.1200/JCO.2004.10.054 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Shen Yang
    • 1
  • Yao Yu
    • 1
  • Li Jun-Min
    • 1
  • Mi Jian-Qing
    • 1
  • Chen Qiu-Sheng
    • 1
  • Chen Yu
    • 1
  • Zhao Wei-Li
    • 1
  • You Jian-Hua
    • 1
  • Zhao Hui-Jin
    • 1
  • Wang Yan
    • 1
  • Wang Li
    • 1
  • Cheng Shu
    • 1
  • Shen Zhi-Xiang
    • 1
  1. 1.Department of Hematology, Shanghai Institute of Hematology, Ruijin HospitalShanghai Jiaotong University Medical SchoolShanghaiChina

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