Thalidomide enhanced the efficacy of CHOP chemotherapy in the treatment of diffuse large B cell lymphoma: A phase II study

Abstract

Cyclophosphamide, doxorubicin, vincristine, and prednisolone plus rituximab (R-CHOP) is the standard treatment for patients with diffuse large B cell lymphoma (DLBCL). However, rituximab cannot be popularly applied in a considerable number of patients with DLBCL because of economic reasons. To develop a new regimen to improve the outcome of these patients is extremely important. In our study, sixty five patients with DLBCL were randomly assigned to thalidomide plus CHOP group (n=32) or to CHOP alone group (n=33). Objective response rates (ORR) and complete remission rates (CRR) were 96.7% and 80.6% in T-CHOP group versus 78.9 % and 57.8 % in CHOP group, respectively (P <0.05). At a median follow-up of 96 months, median PFS for T-CHOP group was still not reached yet, and in CHOP group it was 22.9 months (95% CI [0-50.4]). (P=0.163). Median overall survival (OS) for T-CHOP group was also not reached, and the estimated median OS for CHOP group was 83.5 months, the difference of OS between the two groups is not significant (p=0.263). But, in patients with Bcl-2 positive and Bcl-6 negative, the median PFS in T-CHOP group was longer than that in CHOP group (111.0 vs 8.5 months (P=0.017). In addition, thalidomide did not significantly increase the grade 3/4 toxicity of CHOP. We concluded that the addition of thalidomide to the CHOP regimen significantly improved the CRR and showed a trend of improving clinical outcome in patients with DLBCL, especially for patients with Bcl-2 positive and Bcl-6 negative B-cell phenotype, without increased toxicity.

Progressive Diffuse Large B-cell Lymphoma with TP53 Gene Mutation Treated with Chidamide-Based Chemotherapy

“…Thalidomide and lenalidomide are potent antineoplastic agents for myeloma as well as lymphoma. A Phase II clinical trial comparing thalidomide plus CHOP with CHOP alone has shown that the combination involving thalidomide significantly increased the complete response (CR) rate, particularly in patients with BCL-2-positive and BCL-6-negative DLBCL [22]. A case study has shown that two out of three relapsed elderly patients with DLBCL achieved complete remission using the combination of thalidomide 100 mg and corticosteroids [23].…”

MiR‐30a increases MDSC differentiation and immunosuppressive function by targeting SOCS3 in mice with B‐cell lymphoma

“…B cell lymphomas have a wide range of histological appearances and clinical features at presentation, which makes a precise diagnosis difficult . B‐cell lymphoma is a clonal expansion of neoplastic cells that may result in fatal outcomes . It has been reported that, rather than gaining activity, T cells are exhausted and lose function in B‐cell lymphoma patients .…”

Gemcitabine Rituximab Dexamethasone and Thalidomide as Maintenance in the Treatment of Relapse/Refractory Diffuse Large B-cell Lymphoma

“…Smith, et al [19] reported that the use of lenalidomide and rituximab have serious adverse effects and suggested that the employed doses will be avoid those high doses [19]. Ji, et al [20] has been reported a single study and show that addition of thalidomide to CHOP standard in first treatment od DLBCL, and the addition of thalidomide did not increase acute toxicities [20].…”