Contributions
Abstract: PB1730
Type: Publication Only
Background
The most common high-grade lymphoid malignancy in adults is Diffuse Large B-Cell Lymphoma (DLBCL), which has an increasing incidence with age (1). Over 40% of patients with DLBCL are above the age of 70, and the co-morbidities in this age-group present significant challenges and complexities with regards to selecting and implementing treatment regimens (2).
Aims
We present a retrospective analysis of outcomes for patients with high-grade DLBCL (stage 3 or 4 disease) who have received fewer than 6 cycles of full dose R-CHOP or R-GCVP because of poor tolerability or disease progression with treatment.
Methods
Patients/methods: Retrospective data were collected from the cancer registry for all newly-diagnosed DLBCL patients who received R-CHOP or R-GCVP chemotherapy, with data collected from Jan 2010 to Feb 2017 from Ipswich Hospital NHS trust, United Kingdom. Patients who completed 6 cycles of chemotherapy were excluded. Interim PET-CT scan/staging CT scan was done to assess the disease response to therapy after 2 cycles of chemotherapy. The main baseline characteristics collected were age, sex, ECOG Performance Status, Ann-Arbor Stage and IPI risk stratification. The primary end point was progression-free survival (PFS) from completion of treatment. Secondary end points were overall response rate (ORR), overall survival (OS), and the reasons for premature ceasing of treatment based on graded toxicity according to NCI-CTCAE 4.0.
Results
Results: Out of 87 patients, 12 patients were identified that fulfilled the inclusion criteria. The median age of patients was 72 years (range: 64-88 years), sex distribution was 7 male: 5 female, ECOG PS was 0-2 in 10 (83%) and ≥3 in 2 (17%) of the patients, Ann-Arbor Stage was 3 in 6 patients (50%) and 4 in 6 patients (50%), and IPI score was 3 in all 12 patients. 11 patients received R-CHOP and 1 patient received R-GCVP. The median length of treatment was 3.5 cycles (range: 1-5 cycles). The overall response rate was 50% on interim assessment and 75% at end of treatment assessment scan. The complete and partial response rates at the end of the treatment were 58% and 17% respectively. Progression free survival was 73% at 2 years (8 out of 11 patients) and 50% at 3 years (4 out of 8 patients). The median overall survival of deceased patients (4 out of 12) was 9.5 months (range: 2-42 months) and the median overall survival of living patients (8 out of 12) is at 40.5 months (range: 27-84 months). The most common reasons for stopping the treatment were intolerance of side-effects (4 out of 12) or neutropenic sepsis (3 out of 12). 2 out of 12 patients received an incomplete course of chemotherapy due to non-response or progression of disease with treatment.
Conclusion
Conclusion: DLBCL treated with less than 6 cycles of full dose R-CHOP or R-GCVP chemotherapy may achieve sustained long-term remission in selected patients with high IPI and significant co-morbidity. Further research on disease characteristics including molecular profile is needed to elucidate selected populations who may achieve long-term remission with shorter cycles of chemotherapy. Further insights may derive, for example, from analysis of polymorphism of folate pathway genes and /or of NF-kB,which have been previously suggested as pharmaco-genomic targets in lymphoid neoplasm. A risk stratification model needs to be developed to reduce drug toxicity and other short and long term treatment related complications so as to improve patient experience, and pharmaco-economic benefits.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): DLBCL
Abstract: PB1730
Type: Publication Only
Background
The most common high-grade lymphoid malignancy in adults is Diffuse Large B-Cell Lymphoma (DLBCL), which has an increasing incidence with age (1). Over 40% of patients with DLBCL are above the age of 70, and the co-morbidities in this age-group present significant challenges and complexities with regards to selecting and implementing treatment regimens (2).
Aims
We present a retrospective analysis of outcomes for patients with high-grade DLBCL (stage 3 or 4 disease) who have received fewer than 6 cycles of full dose R-CHOP or R-GCVP because of poor tolerability or disease progression with treatment.
Methods
Patients/methods: Retrospective data were collected from the cancer registry for all newly-diagnosed DLBCL patients who received R-CHOP or R-GCVP chemotherapy, with data collected from Jan 2010 to Feb 2017 from Ipswich Hospital NHS trust, United Kingdom. Patients who completed 6 cycles of chemotherapy were excluded. Interim PET-CT scan/staging CT scan was done to assess the disease response to therapy after 2 cycles of chemotherapy. The main baseline characteristics collected were age, sex, ECOG Performance Status, Ann-Arbor Stage and IPI risk stratification. The primary end point was progression-free survival (PFS) from completion of treatment. Secondary end points were overall response rate (ORR), overall survival (OS), and the reasons for premature ceasing of treatment based on graded toxicity according to NCI-CTCAE 4.0.
Results
Results: Out of 87 patients, 12 patients were identified that fulfilled the inclusion criteria. The median age of patients was 72 years (range: 64-88 years), sex distribution was 7 male: 5 female, ECOG PS was 0-2 in 10 (83%) and ≥3 in 2 (17%) of the patients, Ann-Arbor Stage was 3 in 6 patients (50%) and 4 in 6 patients (50%), and IPI score was 3 in all 12 patients. 11 patients received R-CHOP and 1 patient received R-GCVP. The median length of treatment was 3.5 cycles (range: 1-5 cycles). The overall response rate was 50% on interim assessment and 75% at end of treatment assessment scan. The complete and partial response rates at the end of the treatment were 58% and 17% respectively. Progression free survival was 73% at 2 years (8 out of 11 patients) and 50% at 3 years (4 out of 8 patients). The median overall survival of deceased patients (4 out of 12) was 9.5 months (range: 2-42 months) and the median overall survival of living patients (8 out of 12) is at 40.5 months (range: 27-84 months). The most common reasons for stopping the treatment were intolerance of side-effects (4 out of 12) or neutropenic sepsis (3 out of 12). 2 out of 12 patients received an incomplete course of chemotherapy due to non-response or progression of disease with treatment.
Conclusion
Conclusion: DLBCL treated with less than 6 cycles of full dose R-CHOP or R-GCVP chemotherapy may achieve sustained long-term remission in selected patients with high IPI and significant co-morbidity. Further research on disease characteristics including molecular profile is needed to elucidate selected populations who may achieve long-term remission with shorter cycles of chemotherapy. Further insights may derive, for example, from analysis of polymorphism of folate pathway genes and /or of NF-kB,which have been previously suggested as pharmaco-genomic targets in lymphoid neoplasm. A risk stratification model needs to be developed to reduce drug toxicity and other short and long term treatment related complications so as to improve patient experience, and pharmaco-economic benefits.
Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): DLBCL