The diffuse large B-cell lymphoma - where do we stand now in everyday clinical practice

Abstract

BackgroundDue to superior results observed with the addition of rituximab into treatment of patients with the diffuse large B-cell lymphoma (DLBCL),the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) regimen and its variants became the standard initial treatment of these patients. However, the treatment recommendations are based on results of clinical studies while the conditions of routine treatment are far different from the ones in clinical studies. The aim of this retrospective study was therefore to compare the treatment results of routinely treated patients with the DLBCL to results reported by some larger studies.Patients and methodsTwo hundred and ninety five patients with the DLBCL were treated between 2004 and 2008 according to the then protocol with R-CHOP or R-CHOP-like regimens at the Institute of Oncology Ljubljana. Treatment response was evaluated according to Cheson’s criteria and the disease-free and overall survival by means of Kaplan Meier survival curves.ResultsResponse to treatment in our evaluation diverged from the reported one predominately in the low risk group (international prognostic index [IPI] categorisation) and in the very good prognosis group (revised international prognostic index (R-IPI) categorisation). The determined complete response (CR) rates in other IPI and R-IPI groups were generally within expectations. Also in the disease-free survival the largest discrepancy occurred in the low-risk patient group (3 year disease-free survival rate of 75%) and in the very good prognosis group (4 year disease-free survival rate of 59%). In all other IPI risk groups, the disease-free survival at 3 years (low intermediate risk 76%, high intermediate risk group 57%, and high risk group 53%) agreed very well with the quoted ones. Slightly worse was the compliance of the 4 year disease-free survival rates (72% in the good prognosis and 51% in the poor prognosis group) with the results from the literature. The 3 year overall survival rates (low risk patients 87%, high intermediate risk 61% and high risk patients 51%) were somewhat worse than the reported ones in all IPI subgroups except in the low intermediate risk group (82%). On the other hand, the 4 year overall survival rates of the R-IPI categories (94% in the very good prognosis group, 80% in the good prognosis group, 56% in the poor prognosis group) were much better correlated with the data from the literature.ConclusionsIn total, the treatment outcomes of routinely treated patient with the DLBCL at our institute are quite encouraging when compared to results of some larger studies. There are probably no dilemmas about how to treat young good prognosis patients and patients aged over 60 years at present. However, the 5 year overall survival rate of 76% for the young poor prognosis group is unsatisfying and needs to be improved. At present, quite a few studies are underway to clarify which of the regimens will perform best in this population.

The influence of folate pathway polymorphisms on high-dose methotrexaterelated toxicity and survival in children with non-Hodgkin malignant lymphoma

“…Non-Hodgkin’s lymphomas (NHLs) represent approximately 50% of these diagnoses in children and have an average 10-year incidence in Slovenia of six cases per year. NHL comprises a heterogeneous group of lymphoid neoplasms 1. Among the three major subgroups of childhood NHL according to the World Health Organization Classification, children with lymphoblastic lymphoma of the precursor B- or T-cell types (LBL) are treated according to childhood acute lymphoblastic leukaemia (ALL) protocols2, which include administration of high-dose methotrexate (HD-MTX).…”

Standardized uptake value for 18F-fluorodeoxyglucose is correlated with a high International Prognostic Index and the presence of extranodal involvement in patients with Diffuse Large B-Cell Lymphoma

“…2 Authors have reported that overall survival was significantly reduced with the presence of extranodal involvement even in Rituximab era. [16][17][18] Combining these facts, we considered that both the presence of extranodal disease and higher pretreatment FDG uptake in patients with extranodal involvement were in accordance.…”

“…El valor estandarizado de captación de 18 F-fluorodesoxiglucosa se correlaciona con un índice pronóstico internacional elevado y la presencia de afectación extranodal en pacientes con linfoma B difuso de células grandes Palabras clave: Linfoma B difuso de células grandes Linfoma no Hodgkin Tomografía por emisión de positrones/tomografía computarizada Afectación extraganglionar Valor estandarizado de captación máximo Índice pronóstico internacional r e s u m e n El objetivo de este estudio fue evaluar si el valor estandarizado de captación máximo (SUVmáx) de 18 Ffluorodesoxiglucosa (FDG) se correlaciona con el índice pronóstico internacional (IPI) y la presencia de afectación extranodal en pacientes con linfoma B difuso de células grandes (LBDCG). Material y métodos: Se incluyeron 77 pacientes (40 H, 37 M; edad: 57,2 ± 18,5 años) con LBDCG a los que se efectuó 18 F-FDG PET/TAC para la estadificación inicial.…”

Treatment outcomes and survival in patients with primary central nervous system lymphomas treated between 1995 and 2010 – a single centre report

“…Yet, radiation therapy is associated with a high incidence of neurotoxicity, which is however not seen after the radiation therapy of patients with brain metastases of solid tumors because of their shorter survival or lower tumor dose 20. Although currently available therapeutic regimes prolong the survival, they are in contrast to therapies used to treat systemic lymphomas,21,22 not curative in most patients.…”