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TREATMENT RESULTS IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA FROM HIGH RISK AND HIGH-INTERMEDIATE RISK GROUPS
Author(s):
Iryna Kriachok
,
Iryna Kriachok
Affiliations:
33/43, Lomonosova str.,National Cancer Institute,Kyiv,Ukraine
Kateryna Filonenko
,
Kateryna Filonenko
Affiliations:
Chemotherapy of hemoblastoses,National Cancer Institute,Kyiv,Ukraine
Arina Martynchyk
,
Arina Martynchyk
Affiliations:
Chemotherapy of hemoblastoses,National Cancer Institute,Kyiv,Ukraine
Iryna Titorenko
,
Iryna Titorenko
Affiliations:
Chemotherapy of hemoblastoses,National Cancer Institute,Kyiv,Ukraine
Iana Stepanishyna
,
Iana Stepanishyna
Affiliations:
Chemotherapy of hemoblastoses,National Cancer Institute,Kyiv,Ukraine
Olena Aleksyk
,
Olena Aleksyk
Affiliations:
Chemotherapy of hemoblastoses,National Cancer Institute,Kyiv,Ukraine
Iryna Dyagil
,
Iryna Dyagil
Affiliations:
Radiation hematology,NNCRM,Kyiv,Ukraine
Eugen Kushchevyy
,
Eugen Kushchevyy
Affiliations:
Chemotherapy of hemoblastoses,National Cancer Institute,Kyiv,Ukraine
Zoya Martina
,
Zoya Martina
Affiliations:
Radiation hematology,NNCRM,Kyiv,Ukraine
Viktor Kozlov
Viktor Kozlov
Affiliations:
Hematology,Odessky regional hospital,Odessa,Ukraine
(Abstract release date: 05/18/17) EHA Library. Kriachok I. 05/18/17; 182428; PB1714
Prof. Dr. Iryna Kriachok
Prof. Dr. Iryna Kriachok
Contributions
PDF Abstract
Abstract

Abstract: PB1714

Type: Publication Only

Background
Using of Rituximab-containing regimens, as the «gold standard» of treatment of patients with diffuse large B-cell lymphoma (DLBCL), showed significant improvement in the treatment results throughout all prognostic groups. The “real-life” treatment approaches vary depending on financial support of health-care system in different countries. Unfortunately, treatment results in patients with DLBCL from high and high-intermediate risk groups are still unsatisfying.

Aims
Aim of our study was to compare efficacy and toxicity of different treatment approaches in patients with DLBCL from high risk and high-intermediate risk groups.

Methods
Prospective cohort study was initiated in 2014 in three Ukrainian centers. Patients with newly diagnosed DLBCL and ≥ 3 risk factors according to International Prognostic Index (IPI) were treated according to “investigators decision” with 6-8 cycles of CHOP-like (first group), R-CHOP (second group) or R-DA-EPOCH regimens (third group). Primary end-point was 2-year progression-free survival (PFS), secondary end-points were 2-year overall survival (OS), overall response rate (ORR), complete response rate (CRR), toxicity rates.

Results

104 patients were included into analysis in January 2017, 50 males (48,1 %), 54 females (51,9 %), in the age 23-86 years old, median age 63 years (95 % CІ 60;65). Observation period was 1-64 months, median – 10.5 months. Patients were divided into three groups according to the treatment regimen. Patients treated with CHOP-like regimens were included into the first group (52 patients, 50.0%). Patients treated with R-CHOP were included into the 2nd group (40 patients, 38.5%) and 12 patients (12.5%) treated with R-DA-EPOCH were included into the 3rd group. Significant difference between the groups was observed by the age (younger patients in the 3rd group, p = 0.042) and stages distribution (early stages were more common in the 1st group, p = 0.05).
ORR was 61.5% in the 1st group, 52.5% in the 2nd group and 83.3 % in the 3rd group (p=0.01). CRR was 17.3%, 42.5% and 83.3%, respectively (p<0,001). 2-year PFS was 44,1 ± 9,7% in the 1st group, 74,1 ± 8,8% in the 2nd group and 88,9 ± 10,5% in the 3rd group (р = 0,09). 2-year OS was 51,8 ± 8,7%, 54,8 ± 10,2% and 87,5 ± 11,7%, respectively (р = 0,197).
The rates of anemia, thrombocytopenia and hepatotoxicity were comparable in three groups. Neutropenia, febrile neutropenia and cardiotoxicity were less common in the group treated with R-DA-EPOCH (p=0.05, p=0.051, p<0,01, respectively). Neurotoxicity was more frequent in this group (p=0.043).

Conclusion
The level of ORR and CRR was significantly higher in the R-DA-EPOCH group. 2-year PFS was significantly higher in the R-DA-EPOCH group, as well. There was no significant difference in the level of 2-year OS between the groups. Toxicity was acceptable in all groups. Levels of neutropenia, febrile neutropenia and cardiotoxicity were less common and neurotoxicity was more frequent in the R-DA-EPOCH group. Thus, R-DA-EPOCH could be considered as the most efficient treatment regimen in patients with DLBCL from high and high-intermediate risk groups.

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): Rituximab, International prognostic index, High risk, Diffuse large B cell lymphoma

Abstract: PB1714

Type: Publication Only

Background
Using of Rituximab-containing regimens, as the «gold standard» of treatment of patients with diffuse large B-cell lymphoma (DLBCL), showed significant improvement in the treatment results throughout all prognostic groups. The “real-life” treatment approaches vary depending on financial support of health-care system in different countries. Unfortunately, treatment results in patients with DLBCL from high and high-intermediate risk groups are still unsatisfying.

Aims
Aim of our study was to compare efficacy and toxicity of different treatment approaches in patients with DLBCL from high risk and high-intermediate risk groups.

Methods
Prospective cohort study was initiated in 2014 in three Ukrainian centers. Patients with newly diagnosed DLBCL and ≥ 3 risk factors according to International Prognostic Index (IPI) were treated according to “investigators decision” with 6-8 cycles of CHOP-like (first group), R-CHOP (second group) or R-DA-EPOCH regimens (third group). Primary end-point was 2-year progression-free survival (PFS), secondary end-points were 2-year overall survival (OS), overall response rate (ORR), complete response rate (CRR), toxicity rates.

Results

104 patients were included into analysis in January 2017, 50 males (48,1 %), 54 females (51,9 %), in the age 23-86 years old, median age 63 years (95 % CІ 60;65). Observation period was 1-64 months, median – 10.5 months. Patients were divided into three groups according to the treatment regimen. Patients treated with CHOP-like regimens were included into the first group (52 patients, 50.0%). Patients treated with R-CHOP were included into the 2nd group (40 patients, 38.5%) and 12 patients (12.5%) treated with R-DA-EPOCH were included into the 3rd group. Significant difference between the groups was observed by the age (younger patients in the 3rd group, p = 0.042) and stages distribution (early stages were more common in the 1st group, p = 0.05).
ORR was 61.5% in the 1st group, 52.5% in the 2nd group and 83.3 % in the 3rd group (p=0.01). CRR was 17.3%, 42.5% and 83.3%, respectively (p<0,001). 2-year PFS was 44,1 ± 9,7% in the 1st group, 74,1 ± 8,8% in the 2nd group and 88,9 ± 10,5% in the 3rd group (р = 0,09). 2-year OS was 51,8 ± 8,7%, 54,8 ± 10,2% and 87,5 ± 11,7%, respectively (р = 0,197).
The rates of anemia, thrombocytopenia and hepatotoxicity were comparable in three groups. Neutropenia, febrile neutropenia and cardiotoxicity were less common in the group treated with R-DA-EPOCH (p=0.05, p=0.051, p<0,01, respectively). Neurotoxicity was more frequent in this group (p=0.043).

Conclusion
The level of ORR and CRR was significantly higher in the R-DA-EPOCH group. 2-year PFS was significantly higher in the R-DA-EPOCH group, as well. There was no significant difference in the level of 2-year OS between the groups. Toxicity was acceptable in all groups. Levels of neutropenia, febrile neutropenia and cardiotoxicity were less common and neurotoxicity was more frequent in the R-DA-EPOCH group. Thus, R-DA-EPOCH could be considered as the most efficient treatment regimen in patients with DLBCL from high and high-intermediate risk groups.

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): Rituximab, International prognostic index, High risk, Diffuse large B cell lymphoma

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