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

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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, 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.

Details

Authors
  • Christopher M. Melén
  • Gunilla Enblad
  • Kristina Sonnevi
  • Henna Riikka Junlén
  • Karin E. Smedby
  • Mats Jerkeman
  • Björn Engelbrekt Wahlin
Organisations
External organisations
  • Karolinska University Hospital
  • Uppsala University Hospital
  • Karolinska Institutet
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology

Keywords

  • aaIPI, cytarabine, Diffuse large B-cell lymphoma, intensive chemotherapy, young
Original languageEnglish
Pages (from-to)614-622
Number of pages9
JournalBritish Journal of Haematology
Volume175
Issue number4
Publication statusPublished - 2016 Nov 1
Publication categoryResearch
Peer-reviewedYes

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