Additional rituximab-CHOP (R-CHOP) versus involved-field radiotherapy after a brief course of R-CHOP in limited, non-bulky diffuse large B-cell lymphoma: a retrospective analysis

Junshik Hong; Ae Jin Kim; Jin Sun Park; Seok Ho Lee; Kyu Chan Lee; Jinny Park; Sun Jin Sym; Eun Kyung Cho; Dong Bok Shin; Jae Hoon Lee

doi:10.5045/kjh.2010.45.4.253

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Original Article

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Korean J Hematol 2010; 45(4):

Published online December 31, 2010

https://doi.org/10.5045/kjh.2010.45.4.253

Additional rituximab-CHOP (R-CHOP) versus involved-field radiotherapy after a brief course of R-CHOP in limited, non-bulky diffuse large B-cell lymphoma: a retrospective analysis

Junshik Hong¹, Ae Jin Kim¹, Jin Sun Park¹, Seok Ho Lee², Kyu Chan Lee², Jinny Park^1*, Sun Jin Sym¹, Eun Kyung Cho¹, Dong Bok Shin¹, and Jae Hoon Lee¹

Author Info. +

¹Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea.

²Department of Therapeutic Radiology & Oncology, Gachon University Gil Hospital, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea.

Correspondence to : Correspondence to Jinny Park, M.D., Ph.D. Department of Internal Medicine, Gachon University Gil Hospital, 1198, Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel: +82-32-460-8209, Fax: +82-32-460-3233, jhagnes@gilhospital.com

Received: August 5, 2010; Revised: November 8, 2010; Accepted: November 18, 2010

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

Standard treatment for stage I or non-bulky stage II diffuse large B-cell lymphoma (DLBCL) has been either a brief course of chemotherapy plus involved-field radiotherapy (IFRT) or prolonged cycles of chemotherapy. The introduction of rituximab has necessitated re-evaluation of the treatment for limited disease (LD) DLBCL.

Methods

Thirty-nine LD DLBCL patients (median age, 52 years; range, 24-85) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) were retrospectively analyzed. Treatment outcomes were evaluated, and toxicity, event-free survival (EFS), and overall survival (OS) were compared according to the treatment and risk factors.

Results

The median follow-up duration was 34.6 months (range, 9.1-65.4). The 3-year EFS and OS were 76.0% and 86.0%, respectively. Among the 36 patients who underwent either 3-4 cycles of R-CHOP followed by IFRT (N=22) or 6-8 cycles of R-CHOP (N=14), there was no difference in the 3-year EFS (79.4% vs. 71.6%, P=0.638) and 3-year OS (85.7% vs. 92.9%, P=0.732). Severe neutropenia and neutropenic fever were more frequent in patients treated with R-CHOP alone, with 1 treatment-related mortality. Among the IFRT patients, 1 required hospital admission for IFRT-related complications. No events or deaths were reported among patients without adverse risk factors.

Conclusion

The difference in outcomes between the 2 treatment options was not significant. Analysis of treatment outcomes suggested that baseline characteristics and expected toxicities should be considered in LD DLBCL treatment. Further studies are needed to define the optimal treatment in the rituximab era.

Keywords Diffuse large B-cell lymphoma, Radiotherapy, Rituximab

Article

Original Article

Korean J Hematol 2010; 45(4): 253-259

Published online December 31, 2010 https://doi.org/10.5045/kjh.2010.45.4.253

Additional rituximab-CHOP (R-CHOP) versus involved-field radiotherapy after a brief course of R-CHOP in limited, non-bulky diffuse large B-cell lymphoma: a retrospective analysis

Junshik Hong¹, Ae Jin Kim¹, Jin Sun Park¹, Seok Ho Lee², Kyu Chan Lee², Jinny Park^1*, Sun Jin Sym¹, Eun Kyung Cho¹, Dong Bok Shin¹, and Jae Hoon Lee¹

¹Department of Internal Medicine, Gachon University Gil Hospital, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea.

²Department of Therapeutic Radiology & Oncology, Gachon University Gil Hospital, Gachon University of Medicine and Science, Graduate School of Medicine, Incheon, Korea.

Correspondence to: Correspondence to Jinny Park, M.D., Ph.D. Department of Internal Medicine, Gachon University Gil Hospital, 1198, Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel: +82-32-460-8209, Fax: +82-32-460-3233, jhagnes@gilhospital.com

Received: August 5, 2010; Revised: November 8, 2010; Accepted: November 18, 2010

Abstract

Background

Methods

Results

Conclusion

Keywords: Diffuse large B-cell lymphoma, Radiotherapy, Rituximab

Abstract

Fig 1.

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Figure 1.

Kaplan-Meier curves of (A) event-free survival and (B) overall survival in all 36 patients with stage I or non-bulky stage II diffuse large B-cell lymphoma.

Blood Research 2010; 45: 253-259https://doi.org/10.5045/kjh.2010.45.4.253

Fig 2.

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Figure 2.

Kaplan-Meier survival analysis of (A) event-free survival and (B) overall survival according to treatment options.

Blood Research 2010; 45: 253-259https://doi.org/10.5045/kjh.2010.45.4.253

Fig 3.

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Figure 3.

Kaplan-Meier estimates of (A) event-free survival and (B) overall survival according to adverse risk factors.

Blood Research 2010; 45: 253-259https://doi.org/10.5045/kjh.2010.45.4.253

Table 1 . Patient characteristics..

Abbreviations: IFRT, involved-field radiation therapy; R-CHOP, combination immunochemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone; ECOG, Eastern Cooperative Oncology Group..

Table 2 . Profile of patients' tumor response and pattern of relapse..

^a)R1 denotes tumor response after initial 3-4 cycles of immunochemotherapy, ^b)R2 denotes response after completion of additional immunochemotherapy or radiotherapy, ^c)RT denotes patient treated with subsequent radiotherapy, ^d)CT denotes patient treated with additional immunochemotherapy..

Abbreviations: CR, complete response; CRu, CR-unconfirmed; PR, partial response..

Table 3 . Profile of adverse events during treatment..

^a)The sum of the percentages may not be 100 because of rounding. Abbreviations: IFRT, involved-field radiation therapy; R-CHOP, combination immunochemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone; CTCAE v.3.0, Common Terminology Criteria for Adverse Events Version 3.0; NF, neutropenic fever..