Rituximab in combination with CHOP chemotherapy for the treatment of diffuse large B cell lymphoma in China: a 10-year retrospective follow-up analysis of 437 cases from Shanghai Lymphoma Research Group
The purpose of the study is to evaluate the 10 years follow-up of the efficacy in Chinese patients receiving cyclophosphamide, doxorubicin/epirubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) regimen as the initial treatment for diffuse large B cell lymphoma (DLBCL). We have retrospectively analyzed 437 patients with DLBCL who were newly diagnosed and received CHOP or R-CHOP regimen in six university hospitals and closely followed up after the completion of treatment. For all patients, there were significant differences between R-CHOP and CHOP for overall survival (OS) (median follow-up 86 months, 84.1% vs 70.2%, p = 0.018) and progression-free survival (PFS) (81.5% vs 66.7%, p = 0.015), while elder patients (>60 years old) received higher OS (median follow-up 66 months, 80.7% vs 53.0%, p = 0.011). But for younger patients (≤60 years old), the treatments with rituximab did not demonstrate a significant effect on OS (85.5% vs 79.4%, p = 0.428). In the R-CHOP group, International Prognostic Index (IPI) distinguished three risk groups instead of four risk groups. But in the CHOP group, IPI still distinguished four risk groups. Furthermore, for 212 of 437 patients diagnosed with extranodal involvement DLBCL, R-CHOP regimen provided a longer OS than CHOP regimen did (OS, 89.9% vs 71.7%, p = 0.014). Moreover, patients with extranodal lymphoma had a significant longer survival in rituximab era (OS, 89.9% vs 79.2% for extranodal and nodal, respectively; p = 0.048). The results of this large-scale study suggested that R-CHOP provided a greater survival benefit in the initial treatment of DLBCL. As for the patients with extranodal lymphoma, R-CHOP was also a good choice as first-line treatment. Extranodal disease seems to be an independent good prognostic factor in rituximab era.
KeywordsDiffuse large B cell lymphoma Rituximab Long term Overall survival
This work is supported by Shanghai Lymphoma Research Group. They are composed of Shanghai Ruijin Hospital, Shanghai Changhai Hospital, Shanghai Renji Hospital, Shanghai Zhongshan Hospital, Shanghai No. 1 People’s Hospital, and Shanghai Cancer Center. We would like to express appreciation to the research assistants at each institution for their diligence and attentiveness to detail and the outstanding clinical care delivered by all staffs.
- 3.Ji XL, Shen MS (1999) Extranodal lymphoma in China: an analysis of 943 cases. Chin J Canc 18(5):570–572Google Scholar
- 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 ymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 7:379–391PubMedCrossRefGoogle Scholar
- 9.Swerdlow SH, Campo E, Harris NL et al (2008) WHO classification of tumours of haematopoietic and lymphoid tissues, 4th edn. IARC, LyonGoogle Scholar
- 11.Wu H-J, Zhang Q-Y et al (2005) Comparison of rituximab plus CHOP regimen and CHOP regimen alone for treatment of newly diagnosed patients with diffuse large B-cell lymphoma. Chin J Canc 24(12):1498–1502Google Scholar
- 12.Zhang H-Y, Huang Y, Shen T 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. Chin J Canc 24(12):1421–1426Google Scholar
- 13.Coiffier B, Thieblemont C, Van Den Neste E (2010) Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Groupe d’Etudes des Lymphomes de l’Adulte. Blood 116(12):2040–2045PubMedCrossRefGoogle Scholar
- 17.National Comprehensive Cancer Network (2010) NCCN clinical practice guidelines in oncology: non-Hodgkin’s lymphoma. version 1Google Scholar