Contributions
Abstract: PB1799
Type: Publication Only
Background
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive type of non-Hodgkin's lymphoma, which is characterized by pronounced biological heterogeneity and manifested by various response to induction therapy and the timing of the relapse onset. The risk factors used in clinical practice is not sufficient for correct stratification of patients. This makes it difficult to plan the duration and intensity of therapy. Thus, the current direction is the allocation of new highly informative markers, which help to individualize the choice of the treatment method of DLBCL.
Aims
To evaluate the prognostic potential of individual clinical and hematological indicators as predictors of the first-line of therapy effectiveness in DLBCL patients.
Methods
A retrospective analysis of the 99 patient’s cases was conducted, the age median was 57 (37-80) years. The criteria for study inclusion were: patient's age, DLBCL type, DLBCL morphological subtype, IPI index, disease stage, B-symptoms, LDH level, the method and effectiveness of induction therapy, the status of the patient and the disease in post-induction monitoring. All patients receiving R-CHOP treatment were divided into 4 groups: 54 patients with complete response (CR), 14 with partial response (PR), 16 with resistance to first-line therapy and 9 with early relapse (ER). The median of follow-up duration was 51 (1-60) months.
Results
Among the examined, patients younger than 60 years with a low IPI index were significantly more likely observed (37.7 vs. 13.3%, p<0.0076). Low IPI was reported more often in patients with CR than in resistant form (37 vs. 0%, p<0.001). The frequency of high IPI in groups with CR, PR and resistance to therapy was also significant differed: 7.4, 50 and 68.8%, respectively (p=0.002). B-symptoms in the beginning of the disease in 1, 2 and 4 groups were observed in 42.6, 71.4 and 88.9% of patients, respectively. At the same time, in the group with PR, the frequency of B-symptoms was significantly higher than in patients with CR and ER (p=0.05 vs. p=0.013, respectively). At the first stage of the disease, the CR frequency was significantly higher than the PR (25 vs. 0%, respectively, p=0.016). It was found that the depth of response correlated with the serum LDH level. LDH value within the references were more often observed in patients with CR than with PR (44.4 vs. 14.3%, p=0.039) or resistant variant (44.4 vs. 6.3%, p=0.005). There was a tendency to decrease the effectiveness of R-CHOP in patients with non-GCB subtype of DLBCL in comparison with GCB type: 26.9 vs. 73.1% in group 1 (p=0.174). Four-year disease-free survival (DFS) in patients with CR was not achieved and was 6 months in the group with PR (p=0.001). Four-year overall survival (OS) in the patients with CR, PR and ER was not achieved, and in patients with resistant variant it was 12 months (p<0.001).
Conclusion
A correlation was found between the IPI index, the presence of B-symptoms and the LDH level with the depth of response to induction therapy R-CHOP in DLBCL patients, which indicates a correlation of tumor burden with the effectiveness of treatment. The variability of individual indicators does not allow to correctly predict the probability of reaching a response to treatment. It was found that CR is associated with an increase of the DFS and OS duration. It seems reasonable to search for new risk markers for the early initiation of aggressive treatment in the case of the predicted low efficacy of the standard R-CHOP induction regimen.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): DLBCL, Induction chemotherapy, prognosis
Abstract: PB1799
Type: Publication Only
Background
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive type of non-Hodgkin's lymphoma, which is characterized by pronounced biological heterogeneity and manifested by various response to induction therapy and the timing of the relapse onset. The risk factors used in clinical practice is not sufficient for correct stratification of patients. This makes it difficult to plan the duration and intensity of therapy. Thus, the current direction is the allocation of new highly informative markers, which help to individualize the choice of the treatment method of DLBCL.
Aims
To evaluate the prognostic potential of individual clinical and hematological indicators as predictors of the first-line of therapy effectiveness in DLBCL patients.
Methods
A retrospective analysis of the 99 patient’s cases was conducted, the age median was 57 (37-80) years. The criteria for study inclusion were: patient's age, DLBCL type, DLBCL morphological subtype, IPI index, disease stage, B-symptoms, LDH level, the method and effectiveness of induction therapy, the status of the patient and the disease in post-induction monitoring. All patients receiving R-CHOP treatment were divided into 4 groups: 54 patients with complete response (CR), 14 with partial response (PR), 16 with resistance to first-line therapy and 9 with early relapse (ER). The median of follow-up duration was 51 (1-60) months.
Results
Among the examined, patients younger than 60 years with a low IPI index were significantly more likely observed (37.7 vs. 13.3%, p<0.0076). Low IPI was reported more often in patients with CR than in resistant form (37 vs. 0%, p<0.001). The frequency of high IPI in groups with CR, PR and resistance to therapy was also significant differed: 7.4, 50 and 68.8%, respectively (p=0.002). B-symptoms in the beginning of the disease in 1, 2 and 4 groups were observed in 42.6, 71.4 and 88.9% of patients, respectively. At the same time, in the group with PR, the frequency of B-symptoms was significantly higher than in patients with CR and ER (p=0.05 vs. p=0.013, respectively). At the first stage of the disease, the CR frequency was significantly higher than the PR (25 vs. 0%, respectively, p=0.016). It was found that the depth of response correlated with the serum LDH level. LDH value within the references were more often observed in patients with CR than with PR (44.4 vs. 14.3%, p=0.039) or resistant variant (44.4 vs. 6.3%, p=0.005). There was a tendency to decrease the effectiveness of R-CHOP in patients with non-GCB subtype of DLBCL in comparison with GCB type: 26.9 vs. 73.1% in group 1 (p=0.174). Four-year disease-free survival (DFS) in patients with CR was not achieved and was 6 months in the group with PR (p=0.001). Four-year overall survival (OS) in the patients with CR, PR and ER was not achieved, and in patients with resistant variant it was 12 months (p<0.001).
Conclusion
A correlation was found between the IPI index, the presence of B-symptoms and the LDH level with the depth of response to induction therapy R-CHOP in DLBCL patients, which indicates a correlation of tumor burden with the effectiveness of treatment. The variability of individual indicators does not allow to correctly predict the probability of reaching a response to treatment. It was found that CR is associated with an increase of the DFS and OS duration. It seems reasonable to search for new risk markers for the early initiation of aggressive treatment in the case of the predicted low efficacy of the standard R-CHOP induction regimen.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): DLBCL, Induction chemotherapy, prognosis