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Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma : a Swedish Lymphoma Registry study

Melén, Christopher M.; Enblad, Gunilla; Sonnevi, Kristina; Junlén, Henna Riikka; Smedby, Karin E.; Jerkeman, Mats LU and Wahlin, Björn Engelbrekt (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.

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author
organization
publishing date
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
Federation of European Neuroscience Societies and Blackwell Publishing Ltd
external identifiers
  • scopus:84994910731
  • 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
2017-11-02 00:01:01
@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 &lt; 0·00005), particularly those with aaIPI = 3 (5-year OS, 62% vs. 30%; P &lt; 0·00005). There were no regional differences in therapy or survival in patients with aaIPI &lt; 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},
  keyword      = {aaIPI,cytarabine,Diffuse large B-cell lymphoma,intensive chemotherapy,young},
  language     = {eng},
  month        = {11},
  number       = {4},
  pages        = {614--622},
  publisher    = {Federation of European Neuroscience Societies and Blackwell Publishing Ltd},
  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          = {http://dx.doi.org/10.1111/bjh.14399},
  volume       = {175},
  year         = {2016},
}