Addition of rituximab to the CHOP regimen has no benefit in patients with primary extranodal diffuse large B-cell lymphoma

Geundoo Jang; Dok Hyun Yoon; Shin Kim; Dae Ho Lee; Sang-wook Lee; Jooryung Huh; Cheolwon Suh

doi:10.5045/kjh.2011.46.2.103

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Original Article

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Korean J Hematol 2011; 46(2):

Published online June 21, 2011

https://doi.org/10.5045/kjh.2011.46.2.103

Addition of rituximab to the CHOP regimen has no benefit in patients with primary extranodal diffuse large B-cell lymphoma

Geundoo Jang^1,4, Dok Hyun Yoon¹, Shin Kim¹, Dae Ho Lee¹, Sang-wook Lee², Jooryung Huh³, and Cheolwon Suh^1*

Author Info. +

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁴Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea.

Correspondence to : Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: April 25, 2011; Revised: June 7, 2011; Accepted: June 8, 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background

The addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy (R-CHOP) has significantly improved clinical outcomes for patients with diffuse large B-cell lymphoma (DLBCL). However, new predictors of patient response to R-CHOP have not been established. We aimed to evaluate the impact of R-CHOP compared with CHOP in patients with DLBCL and to establish clinical predictors of better outcomes in these patients.

Methods

We retrospectively identified 177 patients diagnosed with CD20-positive DLBCL and treated with CHOP (N=82) or R-CHOP (N=95). The response rate, event-free survival (EFS), and overall survival (OS) rates were compared between the 2 treatment groups. All patients were classified into primary extranodal lymphoma (PENL) or nodal lymphoma (NL) subgroups, and the clinical parameters of each subgroup were analyzed.

Results

The overall response rate was higher in R-CHOP group (95% vs. 84%, P=0.07). The 3-year EFS rate was significantly higher in R-CHOP group (71% vs. 52%, P=0.013), but the OS rate was comparable between the 2 groups (79% vs. 69%, P=0.23). A significant survival benefit was seen with R-CHOP compared to CHOP therapy in NL patients (P=0.002 for EFS and 0.04 for OS). Multivariate analyses confirmed that R-CHOP therapy is an independent prognostic factor for EFS (hazard ratio of 0.32 [0.17-0.62], P=0.001) and OS (hazard ratio of 0.4 [0.18-0.87], P=0.02) in NL patients.

Conclusion

Patients in the PENL group did not benefit from R-CHOP chemotherapy.

Keywords CHOP, Diffuse large B-cell lymphoma, Rituximab, Primary extranodal lymphoma

Article

Original Article

Korean J Hematol 2011; 46(2): 103-110

Published online June 21, 2011 https://doi.org/10.5045/kjh.2011.46.2.103

Addition of rituximab to the CHOP regimen has no benefit in patients with primary extranodal diffuse large B-cell lymphoma

Geundoo Jang^1,4, Dok Hyun Yoon¹, Shin Kim¹, Dae Ho Lee¹, Sang-wook Lee², Jooryung Huh³, and Cheolwon Suh^1*

¹Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁴Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea.

Correspondence to: Correspondence to Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3209, Fax: +82-2-3010-6961, csuh@amc.seoul.kr

Received: April 25, 2011; Revised: June 7, 2011; Accepted: June 8, 2011

Abstract

Background

Methods

Results

Conclusion

Patients in the PENL group did not benefit from R-CHOP chemotherapy.

Keywords: CHOP, Diffuse large B-cell lymphoma, Rituximab, Primary extranodal lymphoma

Abstract

Fig 1.

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Figure 1.

Kaplan-Meier curves for (A) event-free survival and (B) overall survival in all 177 patients classified on the basis of the treatment regimen.

Blood Research 2011; 46: 103-110https://doi.org/10.5045/kjh.2011.46.2.103

Fig 2.

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Figure 2.

Kaplan-Meier curves for (A) event-free survival and (B) overall survival in patients with nodal lymphoma; (C) event-free survival, and (D) overall survival in patients with primary extranodal lymphoma classified on the basis of the treatment regimen.

Blood Research 2011; 46: 103-110https://doi.org/10.5045/kjh.2011.46.2.103

Fig 3.

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Figure 3.

Kaplan-Meier curves for (A) event-free survival and (B) overall survival in patients treated with R-CHOP classified on the basis of the redistributed International Prognostic Index score.

Blood Research 2011; 46: 103-110https://doi.org/10.5045/kjh.2011.46.2.103

Table 1 . Baseline patient characteristics in CHOP and R-CHOP groups..

Abbreviations: CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CHOP, rituximab-CHOP; ECOG PS, Eastern Clinical Oncology Group performance scale; LDH, lactate dehydrogenase; BM, bone marrow; IPI, international prognostic index; PENL, primary extranodal lymphoma; NL, nodal lymphoma..

Table 2 . Comparison of treatment responses of PENL and NL groups according to the treatment regimen..

^a)7 patients were not evaluated (4 in the PENL and 3 in the NL group), ^b)Fisher's exact test..

Abbreviations: PENL, primary extranodal lymphoma; NL, nodal lymphoma; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CHOP, rituximab-CHOP; CR, complete response; PR, partial response; OR, overall response..

Table 3 . Prognostic factor analysis in the NL group (N=105)..

^a)Log-rank test, ^b)Cox proportional hazard model..

Abbreviations: NL, nodal lymphoma; EFS, event-free survival; OS, overall survival; HR, hazard ratio; CI, Confidence interval; LDH, lactatedoxorubicin, vincristine, and prednisone; R-CHOP, rituximab-CHOP..

Table 4 . Prognostic factor analysis in the PENL group (N=72)..

^a)Log-rank test, ^b)Cox proportional hazard model..

Abbreviations: PENL, primary extranodal lymphoma; EFS, event-free survival; OS, overall survival; HR, hazard ratio; CI, confidence interval; ECOG PS, Eastern Clinical Oncology Group performance scale; LDH, lactate dehydrogenase; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; R-CHOP, rituximab-CHOP..