Improved therapeutic outcomes of DLBCL after introduction of rituximab in Korean patients

Abstract

With improvements in medical care and the resultant positive impact on life expectancy over the past few decades, the proportion of the population aged .65 years has seen significant increase, with the very elderly (age .80 years) expressed as a percentage of those aged .65 years almost doubling since 1950 (13.3% in 1950 increasing to 25.3% in 2015). 1 Like most cancers, the probability of acquiring non-Hodgkin lymphoma (NHL) increases with age (0.2% to 0.3% in those aged ,50 years and 1.4% to 1.8% in those aged .69 years). 2 Moreover, recent statistics also suggest an increase in the incidence of NHL, especially among men. 2 Because the mean age at diagnosis of diffuse large B-cell lymphoma (DLBCL) is 70 years, 3 there has been a number of studies focusing on the elderly with DLBCL, more so after the introduction of rituximab (R), the monoclonal antibody directed against CD-20 on B cell. 4 However, a majority of patients in these studies were in the age group of 60 to 80 years, 5-7 and the very elderly (age .80 years) were mostly not part of these studies due to their multiple comorbidities, poor performance status, or concerns about chemotherapy-induced toxicities that preclude optimizing therapy. 8-10 Hence, there is a lack of definite consensus regarding treatment of DLBCL in the 801 age group. However, due to the increase in life expectancy and increase in incidence of NHL, especially DLBCL, among octogenarians, there have been a few recent studies, mostly retrospective, dealing with patients in this age group. 11-13 Some of these studies have shown improved survival outcomes when standard therapy with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is used rather than observation or suboptimal therapy, whereas others showed better survival and tolerability with less toxic non-anthracycline-based therapy or dose reduction in various components of R-CHOP. 14,15 However, there are little data on DLBCL on those aged .90 years. 16

Impact of Inadequate Doses of Rituximab in the Treatment of Diffuse Large B Cell Lymphoma in Malaysian Patients

“…The results from European Groupe D'Estude des Lymphomes des L'Adulte LNH-98-5 study (GELA) study demonstrated that 5 year overall survival (OS) is significantly higher in elderly patients with rituximab combination chemotherapy (Coiffer et al, 2002). In younger patients who had R-CHOP like chemotherapy had an increased 3-year event-free survival and OS compared to those without rituximab; 79% vs 59% and 93% vs 84% respectively (Pfreundschuh et al, 2006) More recently, the Asia groups including the Japanese, Korean, Chinese and Singaporean had also confirmed similar findings in patients with DLBCL (Park et al, 2006;Li et al, 2007;Ngo et al, 2008;Nishimori et al, 2009;Seiki et al, 2010). However, within the Asian countries, there are many which have limited health care resources in treating patients with lymphoma.…”

“…R-CHOP or CHOP like chemotherapy has proven to improve overall survival of patients with aggressive NHL (Coiffer et al, 2002;Feugier et al, 2005;Sehn et al, 2005;Pfreundschuh et al, 2006). The results are indisputable and many studies done within Asia region had also proven so (Park et al, 2006;Li et al, 2007;Nishimori et al, 2009). A study which evaluated the outcomes of Western and Asian patients with DLBCL treated with R-CHOP found no difference in OS and progression free survival (PFS) (Castillo et al, 2013).…”

Pellino 1 promotes lymphomagenesis by deregulating BCL6 polyubiquitination

“…To further examine the relationship between PELI1 expression and BCL6 expression in human cancer, PELI1 and BCL6 levels were assessed in 113 patients with DLBCLs classified according to World Health Organization guidelines (Figure 7). DLBCLs represent the most common form of non-Hodgkin lymphomas (NHLs) worldwide, accounting for approximately 40% of all new cases of lymphomas and 68% of all NHL cases among adult patients in Korea (13,22). In addition, BCL6 is known to facilitate lymphomagenesis of DLBCLs (12).…”

Combination of rituximab with chemotherapy in diffuse large B‐cell lymphoma. Evaluation in daily practice before and after approval of rituximab in this indication

“…Park et al have reported an outcome benefit for 81 Korean patients treated with CHOP plus rituximab as compared to a historical cohort of 214 patients treated with the CHOP regimen [14]. Patients deemed palliative at diagnosis had been excluded from the analyses and the two studies have therefore been performed on selected patient populations.…”