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Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma: a Swedish Lymphoma Registry study
Dept Med, Div Haematol, Huddinge, Sweden.;Karolinska Inst, Stockholm, Sweden.;Karolinska Univ Hosp, Haematol Ctr, Stockholm, Sweden..
Univ Uppsala Hosp, Dept Oncol, Uppsala, Sweden..
Dept Med, Div Haematol, Huddinge, Sweden.;Karolinska Inst, Stockholm, Sweden.;Karolinska Univ Hosp, Haematol Ctr, Stockholm, Sweden..
Dept Med, Div Haematol, Huddinge, Sweden.;Karolinska Inst, Stockholm, Sweden.;Karolinska Univ Hosp, Haematol Ctr, Stockholm, Sweden..
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2016 (English)In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141, Vol. 175, no 4, 614-622 p.Article in journal (Refereed) Published
Abstract [en]

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 60years 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=0002); the corresponding estimates were 40%, 55%, and 92% in aaIPI=3 (P=0014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI2: three were Moderate (more R-CHOP) and three Intensive (more R-CHOEP and R-HDA/M). Patients with aaIPI2 who were treated in the Intensive Regions, showed better OS (P<000005), particularly those with aaIPI=3 (5-year OS, 62% vs. 30%; P<000005). 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.

Place, publisher, year, edition, pages
2016. Vol. 175, no 4, 614-622 p.
Keyword [en]
Diffuse large B-cell lymphoma, intensive chemotherapy, young, aaIPI, cytarabine
National Category
Hematology
Identifiers
URN: urn:nbn:se:uu:diva-310764DOI: 10.1111/bjh.14399ISI: 000387807300008PubMedID: 27790699OAI: oai:DiVA.org:uu-310764DiVA: diva2:1057933
Funder
Swedish Cancer SocietySwedish Society for Medical Research (SSMF)Stockholm County Council
Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2016-12-19Bibliographically approved

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