DIFFUSE LARGE B-CELL LYMPHOMA IN HIGH RISK AAIPI 2-3 YOUNG PATIENTS: CLINICAL PRESENTATION AND SURVIVAL AFTER FIRST LINE STANDARD R-CHOP THERAPY.
(Abstract release date: 05/19/16)
EHA Library. Salas Gay M. 06/09/16; 134631; PB1731
Mrs. Maria Queralt Salas Gay
Contributions
Contributions
Abstract
Abstract: PB1731
Type: Publication Only
Background
The outcome of diffuse large B-cell lymphoma (DLBCL) has substantially improved with the addition of Rituximab (R) to chemotherapy regimens although there is not a randomized trial comparing R-chemotherapy versus chemotherapy alone in high risk young patients.
Aims
We aim to present a retrospective study of the clinical, immunohistochemical features (IHC), and survival of patients≤ 60 years with aaIPI 2-3 treated with 6 cycles of standard R-CHOP in a single center.
Methods
Three hundred sixty seven patients were diagnosed of DLBCL from January of 2004 to June of 2015 in our centre, 119 (32.4%) were ≤ 60 years and 63 (52.9%) of them had aaIPI 2-3. Cases were classified as germinal center (GB) or activated B-cell (ABC) subtype according with the IHC Hans’s algorithm. Clinical and biological features, progression free survival (PFS) and overall survival (OS) were analyzed. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.
Results
Sixty three young patients with aaIPI 2-3 DLBCL were included. Median age was 50 years (range 21-60), 29 (46%) were male. Clinical characteristics at presentation were: ECOG ≥2 in 45 (67.2%), Ann Arbor stage III-IV 53 (84.1%), B symptoms 27 (42.9%), Bulky >5cm mass 19 (30.2%), extra nodal disease 43 (68.3%), CNS involvement 3 (4.8%), high LDH 37/53 (69.8%), high B2M 12/25 (48%), aaIPI2 48 (71.6%) and aaIPI3 15 (23.8%).Thirty-six cases had data to be classified by IHC: 22 (61.1%) CGB and 14(38.9%) ABC. Sixty-two (98.4%) patients started treatment: 58 (92%) with 6 cycles of R-CHOP and 4 (8%) of R-CHOP-like (2 R-CNOP, 1 R-Bortezomib-CAP and 1 GA101-CHOP). Nine (14.2%) patients did not complete treatment, 5 due to adverse events (2 not recorded, 2 severe infections, 1 cardiac event) and 4 due to progression. Intrathecal prophylaxis was administered in 10 (16.1%) cases and as therapy in the 3 patients with CNS involvement. Response was evaluated with PET/CT in 41 (71.8%) patients. Intention to treat response rate was: CR 46 (73%), PR 4 (6.3%), refractory disease 9 (14.3%), not evaluable 4 (6.3%). With a median follow-up of 44 months PFS was 69% and OS was 70%. PFS was 75.2%in patients with aaIPI 2 and 46.7% in patients with aaIPI3 (p=0.02). OS was 77.4% and 38.7% respectively (p=0.01). Sixteen patients relapsed or progressed[AS1] , 4 were lost of control and 12[AS2] were treated with a second line regimen in our center (9 R-ESHAP, 1 MTX-ARAC, 1 Burkitt regimen and 1 DHAP). Only 3 patients achieved enough response (2 CR and 1 PR) to[AS3] undergo an autologous stem cell transplant. After second line therapy, median PFS was 2 months and median OS was 4 months.
Conclusion
Six cycles of R-CHOP is an effective first line regimen for young patients with aaIPI2, but alternative therapies are needed for patients with aaIPI3. Moreover, only a small percentage of patients who fail first line therapy are rescued. Clinical trials with new drugs are needed especially for the very high risk population.
Session topic: E-poster
Keyword(s): Lymphoma, Survival, Treatment, Young adult
Type: Publication Only
Background
The outcome of diffuse large B-cell lymphoma (DLBCL) has substantially improved with the addition of Rituximab (R) to chemotherapy regimens although there is not a randomized trial comparing R-chemotherapy versus chemotherapy alone in high risk young patients.
Aims
We aim to present a retrospective study of the clinical, immunohistochemical features (IHC), and survival of patients≤ 60 years with aaIPI 2-3 treated with 6 cycles of standard R-CHOP in a single center.
Methods
Three hundred sixty seven patients were diagnosed of DLBCL from January of 2004 to June of 2015 in our centre, 119 (32.4%) were ≤ 60 years and 63 (52.9%) of them had aaIPI 2-3. Cases were classified as germinal center (GB) or activated B-cell (ABC) subtype according with the IHC Hans’s algorithm. Clinical and biological features, progression free survival (PFS) and overall survival (OS) were analyzed. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.
Results
Sixty three young patients with aaIPI 2-3 DLBCL were included. Median age was 50 years (range 21-60), 29 (46%) were male. Clinical characteristics at presentation were: ECOG ≥2 in 45 (67.2%), Ann Arbor stage III-IV 53 (84.1%), B symptoms 27 (42.9%), Bulky >5cm mass 19 (30.2%), extra nodal disease 43 (68.3%), CNS involvement 3 (4.8%), high LDH 37/53 (69.8%), high B2M 12/25 (48%), aaIPI2 48 (71.6%) and aaIPI3 15 (23.8%).Thirty-six cases had data to be classified by IHC: 22 (61.1%) CGB and 14(38.9%) ABC. Sixty-two (98.4%) patients started treatment: 58 (92%) with 6 cycles of R-CHOP and 4 (8%) of R-CHOP-like (2 R-CNOP, 1 R-Bortezomib-CAP and 1 GA101-CHOP). Nine (14.2%) patients did not complete treatment, 5 due to adverse events (2 not recorded, 2 severe infections, 1 cardiac event) and 4 due to progression. Intrathecal prophylaxis was administered in 10 (16.1%) cases and as therapy in the 3 patients with CNS involvement. Response was evaluated with PET/CT in 41 (71.8%) patients. Intention to treat response rate was: CR 46 (73%), PR 4 (6.3%), refractory disease 9 (14.3%), not evaluable 4 (6.3%). With a median follow-up of 44 months PFS was 69% and OS was 70%. PFS was 75.2%in patients with aaIPI 2 and 46.7% in patients with aaIPI3 (p=0.02). OS was 77.4% and 38.7% respectively (p=0.01). Sixteen patients relapsed or progressed[AS1] , 4 were lost of control and 12[AS2] were treated with a second line regimen in our center (9 R-ESHAP, 1 MTX-ARAC, 1 Burkitt regimen and 1 DHAP). Only 3 patients achieved enough response (2 CR and 1 PR) to[AS3] undergo an autologous stem cell transplant. After second line therapy, median PFS was 2 months and median OS was 4 months.
Conclusion
Six cycles of R-CHOP is an effective first line regimen for young patients with aaIPI2, but alternative therapies are needed for patients with aaIPI3. Moreover, only a small percentage of patients who fail first line therapy are rescued. Clinical trials with new drugs are needed especially for the very high risk population.
Session topic: E-poster
Keyword(s): Lymphoma, Survival, Treatment, Young adult
Abstract: PB1731
Type: Publication Only
Background
The outcome of diffuse large B-cell lymphoma (DLBCL) has substantially improved with the addition of Rituximab (R) to chemotherapy regimens although there is not a randomized trial comparing R-chemotherapy versus chemotherapy alone in high risk young patients.
Aims
We aim to present a retrospective study of the clinical, immunohistochemical features (IHC), and survival of patients≤ 60 years with aaIPI 2-3 treated with 6 cycles of standard R-CHOP in a single center.
Methods
Three hundred sixty seven patients were diagnosed of DLBCL from January of 2004 to June of 2015 in our centre, 119 (32.4%) were ≤ 60 years and 63 (52.9%) of them had aaIPI 2-3. Cases were classified as germinal center (GB) or activated B-cell (ABC) subtype according with the IHC Hans’s algorithm. Clinical and biological features, progression free survival (PFS) and overall survival (OS) were analyzed. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.
Results
Sixty three young patients with aaIPI 2-3 DLBCL were included. Median age was 50 years (range 21-60), 29 (46%) were male. Clinical characteristics at presentation were: ECOG ≥2 in 45 (67.2%), Ann Arbor stage III-IV 53 (84.1%), B symptoms 27 (42.9%), Bulky >5cm mass 19 (30.2%), extra nodal disease 43 (68.3%), CNS involvement 3 (4.8%), high LDH 37/53 (69.8%), high B2M 12/25 (48%), aaIPI2 48 (71.6%) and aaIPI3 15 (23.8%).Thirty-six cases had data to be classified by IHC: 22 (61.1%) CGB and 14(38.9%) ABC. Sixty-two (98.4%) patients started treatment: 58 (92%) with 6 cycles of R-CHOP and 4 (8%) of R-CHOP-like (2 R-CNOP, 1 R-Bortezomib-CAP and 1 GA101-CHOP). Nine (14.2%) patients did not complete treatment, 5 due to adverse events (2 not recorded, 2 severe infections, 1 cardiac event) and 4 due to progression. Intrathecal prophylaxis was administered in 10 (16.1%) cases and as therapy in the 3 patients with CNS involvement. Response was evaluated with PET/CT in 41 (71.8%) patients. Intention to treat response rate was: CR 46 (73%), PR 4 (6.3%), refractory disease 9 (14.3%), not evaluable 4 (6.3%). With a median follow-up of 44 months PFS was 69% and OS was 70%. PFS was 75.2%in patients with aaIPI 2 and 46.7% in patients with aaIPI3 (p=0.02). OS was 77.4% and 38.7% respectively (p=0.01). Sixteen patients relapsed or progressed[AS1] , 4 were lost of control and 12[AS2] were treated with a second line regimen in our center (9 R-ESHAP, 1 MTX-ARAC, 1 Burkitt regimen and 1 DHAP). Only 3 patients achieved enough response (2 CR and 1 PR) to[AS3] undergo an autologous stem cell transplant. After second line therapy, median PFS was 2 months and median OS was 4 months.
Conclusion
Six cycles of R-CHOP is an effective first line regimen for young patients with aaIPI2, but alternative therapies are needed for patients with aaIPI3. Moreover, only a small percentage of patients who fail first line therapy are rescued. Clinical trials with new drugs are needed especially for the very high risk population.
Session topic: E-poster
Keyword(s): Lymphoma, Survival, Treatment, Young adult
Type: Publication Only
Background
The outcome of diffuse large B-cell lymphoma (DLBCL) has substantially improved with the addition of Rituximab (R) to chemotherapy regimens although there is not a randomized trial comparing R-chemotherapy versus chemotherapy alone in high risk young patients.
Aims
We aim to present a retrospective study of the clinical, immunohistochemical features (IHC), and survival of patients≤ 60 years with aaIPI 2-3 treated with 6 cycles of standard R-CHOP in a single center.
Methods
Three hundred sixty seven patients were diagnosed of DLBCL from January of 2004 to June of 2015 in our centre, 119 (32.4%) were ≤ 60 years and 63 (52.9%) of them had aaIPI 2-3. Cases were classified as germinal center (GB) or activated B-cell (ABC) subtype according with the IHC Hans’s algorithm. Clinical and biological features, progression free survival (PFS) and overall survival (OS) were analyzed. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.
Results
Sixty three young patients with aaIPI 2-3 DLBCL were included. Median age was 50 years (range 21-60), 29 (46%) were male. Clinical characteristics at presentation were: ECOG ≥2 in 45 (67.2%), Ann Arbor stage III-IV 53 (84.1%), B symptoms 27 (42.9%), Bulky >5cm mass 19 (30.2%), extra nodal disease 43 (68.3%), CNS involvement 3 (4.8%), high LDH 37/53 (69.8%), high B2M 12/25 (48%), aaIPI2 48 (71.6%) and aaIPI3 15 (23.8%).Thirty-six cases had data to be classified by IHC: 22 (61.1%) CGB and 14(38.9%) ABC. Sixty-two (98.4%) patients started treatment: 58 (92%) with 6 cycles of R-CHOP and 4 (8%) of R-CHOP-like (2 R-CNOP, 1 R-Bortezomib-CAP and 1 GA101-CHOP). Nine (14.2%) patients did not complete treatment, 5 due to adverse events (2 not recorded, 2 severe infections, 1 cardiac event) and 4 due to progression. Intrathecal prophylaxis was administered in 10 (16.1%) cases and as therapy in the 3 patients with CNS involvement. Response was evaluated with PET/CT in 41 (71.8%) patients. Intention to treat response rate was: CR 46 (73%), PR 4 (6.3%), refractory disease 9 (14.3%), not evaluable 4 (6.3%). With a median follow-up of 44 months PFS was 69% and OS was 70%. PFS was 75.2%in patients with aaIPI 2 and 46.7% in patients with aaIPI3 (p=0.02). OS was 77.4% and 38.7% respectively (p=0.01). Sixteen patients relapsed or progressed[AS1] , 4 were lost of control and 12[AS2] were treated with a second line regimen in our center (9 R-ESHAP, 1 MTX-ARAC, 1 Burkitt regimen and 1 DHAP). Only 3 patients achieved enough response (2 CR and 1 PR) to[AS3] undergo an autologous stem cell transplant. After second line therapy, median PFS was 2 months and median OS was 4 months.
Conclusion
Six cycles of R-CHOP is an effective first line regimen for young patients with aaIPI2, but alternative therapies are needed for patients with aaIPI3. Moreover, only a small percentage of patients who fail first line therapy are rescued. Clinical trials with new drugs are needed especially for the very high risk population.
Session topic: E-poster
Keyword(s): Lymphoma, Survival, Treatment, Young adult
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