Is rituximab-based chemotherapy a standard practice in the treatment of B-NHLs in the developing world.

Abstract

e19533 Background: B Non Hodgkin Lymphoma (B-NHL) constitutes 90% of all NHLs. Surface CD20 is expressed in most of them. Standard of care worldwide for B NHLs currently is rituximab-based chemotherapy. In the present era, still rituximab-based chemotherapy is seldom used in India. We tried to analyze the proportion of eligible patients who received rituximab during their first line treatment and their outcome. Methods: We retrospectively analyzed all the cases of NHL patients registered at our center from 2001 to 2010. We defined “Refusal to treatment” as rejection of any therapeutic intervention, “abandonment” if treatment was initiated but not completed, “lost to follow up” as patients who have completed treatment, but missed the subsequent appointments. Results: A total of 1,351 cases of NHLs were registered during 2001-2010. B-NHLs constituted 90.6%. DLBCL accounted for 78.2% of all B-NHLs followed by follicular lymphoma (14.6%). Out of the 1,216 B-NHL patients registered, less than a third (377/1216 i.e 31%) were started on treatment, rest (69%) refused treatment. Four-fifths (79.3%) of the patients could complete at least 4 cycles of the intended chemotherapy, whereas 20.7% of them abandoned treatment in between. Rituximab-based chemotherapy could be initiated in only a quarter (94/377, 24.9%) of the eligible patients, out of which 68% (65/94) completed at least 4 cycles. Chemotherapy without rituximab was initiated in the remaining 75.1% of the patients, of which 78%(221/283) could complete at least 4 cycles. Among the 65 patients who completed at least 4 cycles of rituximab-based chemotherapy, 52% (34/65) were still alive without any evidence of disease as compared to 19% (42/221) of the patients who received chemotherapy without Rituximab at a median follow up of 17 months (range 1-125 months) p<0.05. The proportion of patients who were lost to follow up with evidence of disease at their last visit in the clinic was 4%(3/65) vs. 39%(86/221), in the rituximab vs. non-rituximab-containing chemotherapy groups respectively. Conclusions: Only 7.7% (94/1216) of the eligible B-NHL patients were able to receive rituximab-based chemotherapy. A distinct survival advantage is noted in patients who received rituximab.