Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma : a Swedish Lymphoma Registry study
(2016) In British Journal of Haematology 175(4). p.614-622- Abstract
Young patients with diffuse large B-cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP), CHOP-etoposide (R-CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R-HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aaIPI) ≥ 2, the 5-year overall survival (OS) was 70%, 76% and 85% after R-CHOP,... (More)
Young patients with diffuse large B-cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP), CHOP-etoposide (R-CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R-HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aaIPI) ≥ 2, the 5-year overall survival (OS) was 70%, 76% and 85% after R-CHOP, R-CHOEP and R-HDA/M, respectively (P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aaIPI = 3 (P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI ≥ 2: three were “Moderate” (more R-CHOP) and three “Intensive” (more R-CHOEP and R-HDA/M). Patients with aaIPI ≥ 2 who were treated in the Intensive Regions, showed better OS (P < 0·00005), particularly those with aaIPI = 3 (5-year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aaIPI < 2. We conclude that in younger high-risk patients, survival appears superior after more intensive therapy than R-CHOP.
(Less)
- author
- Melén, Christopher M. ; Enblad, Gunilla ; Sonnevi, Kristina ; Junlén, Henna Riikka ; Smedby, Karin E. ; Jerkeman, Mats LU and Wahlin, Björn Engelbrekt
- organization
- publishing date
- 2016-11-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- aaIPI, cytarabine, Diffuse large B-cell lymphoma, intensive chemotherapy, young
- in
- British Journal of Haematology
- volume
- 175
- issue
- 4
- pages
- 9 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:84994910731
- pmid:27790699
- wos:000387807300008
- ISSN
- 0007-1048
- DOI
- 10.1111/bjh.14399
- language
- English
- LU publication?
- yes
- id
- 3d54597d-76e3-4e52-95de-d2d911792f64
- date added to LUP
- 2016-12-08 14:52:38
- date last changed
- 2024-01-04 18:24:49
@article{3d54597d-76e3-4e52-95de-d2d911792f64,
abstract = {{<p>Young patients with diffuse large B-cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP), CHOP-etoposide (R-CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R-HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aaIPI) ≥ 2, the 5-year overall survival (OS) was 70%, 76% and 85% after R-CHOP, R-CHOEP and R-HDA/M, respectively (P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aaIPI = 3 (P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI ≥ 2: three were “Moderate” (more R-CHOP) and three “Intensive” (more R-CHOEP and R-HDA/M). Patients with aaIPI ≥ 2 who were treated in the Intensive Regions, showed better OS (P < 0·00005), particularly those with aaIPI = 3 (5-year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aaIPI < 2. We conclude that in younger high-risk patients, survival appears superior after more intensive therapy than R-CHOP.</p>}},
author = {{Melén, Christopher M. and Enblad, Gunilla and Sonnevi, Kristina and Junlén, Henna Riikka and Smedby, Karin E. and Jerkeman, Mats and Wahlin, Björn Engelbrekt}},
issn = {{0007-1048}},
keywords = {{aaIPI; cytarabine; Diffuse large B-cell lymphoma; intensive chemotherapy; young}},
language = {{eng}},
month = {{11}},
number = {{4}},
pages = {{614--622}},
publisher = {{Wiley-Blackwell}},
series = {{British Journal of Haematology}},
title = {{Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma : a Swedish Lymphoma Registry study}},
url = {{https://lup.lub.lu.se/search/files/25234812/17967666.pdf}},
doi = {{10.1111/bjh.14399}},
volume = {{175}},
year = {{2016}},
}