Current Concepts in Lymphoma Biology: Effect on Management and Outcome (original) (raw)
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Diagnosis and treatment of diffuse large B-cell lymphoma
Swiss Medical Weekly, 2012
Diffuse large B-cell lymphoma (DLBCL) is the most frequently-occurring type of malignant lymphoma in the Western world. It has an aggressive natural history, with a median survival of less than one year if left untreated. Immunochemotherapy regimens, consisting of the anti-CD20 antibody rituximab typically in combination with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), are currently the treatment backbone. Despite remarkable progress in improving patient survival, clinical outcomes are still unsatisfactory for certain subsets of patients, including the elderly and very elderly and those with highly aggressive disease. This review outlines some of the current treatment strategies for DLBCL and discusses the main issues that affect clinical practice.
BIRDEM Medical Journal
Background: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous group of hematological malignancy of large B lymphocytes with a diffuse growth pattern. It is the most common type of adult non-Hodgkin lymphoma (NHL), making up to 30-40% of NHL. Although DLBCL is potentially curable, it remains a challenging lymphoma to manage because of the biological and clinical heterogeneity of the disease.Aim of the study was to compare the outcome of different chemotherapeutic regimens in newly diagnosed DLBCL patients. Methods: This quasi-experimental study was conducted at Department ofHematology,Dhaka Medical College Hospital(DMCH) from January 2018 to June 2019 including nineteen newly diagnosed DLBCL with stage I to IV A/B cases. Protocol was approved by ethical review committee (ERC) of DMCH. Patients aged e”18 years and < 65 years were enrolled for this study and were divided into two groups as arm A treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, prednison...
International Journal of Hematology, 2009
The influence of the germinal-center B-cell (GCB) and the non-GCB phenotypes of diffuse large B-cell lymphoma (DLBCL) on the outcome of 92 patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or CHOP-like chemotherapy, with or without rituximab was determined in this study. The differentiation between the GCB and non-GCB types was arrived at by immunohistochemistry using previously published criteria. Thirty-nine patients had the GCB and 53 had the non-GCB type of DLBCL. Forty-nine patients were treated with rituximab and chemotherapy; 43 were treated with chemotherapy alone. The GCB and non-GCB group did not differ in their international prognostic index factors and score, presence of bulky disease, or frequency of rituximab treatment. Median follow-up of the surviving patients was carried out for 37 months. There was no difference between the GCB and non-GCB groups in both overall response rates (67 vs. 70%, respectively) and estimated rates of 3-year event-free (46 vs. 49%, respectively) and overall (54 vs. 56%, respectively) survival. In addition, no differences of the outcomes were observed between the subgroups treated with or without rituximab. The patients of this study with immunohistochemically determined GCB-type DLBCL did not have an improved prognosis, irrespective of whether they had received rituximab or not.
Leukemia & Lymphoma, 2010
To study the main clinico-biological characteristics and the outcome of patients with diffuse large B-cell lymphoma (DLBCL) according to the primary site (nodal vs. extranodal), we included 262 patients consecutively diagnosed with DLBCL in a single institution, 5 years before and after immunochemotherapy was considered as the standard treatment. Altogether 116 patients received CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone) and 146 rituximab plus CHOP (R-CHOP). The primary site was the lymph node in 140 patients (53%), Waldeyer's ring (WR) in 22, gastrointestinal (GI) in 33, and other extranodal in 67. The addition of rituximab significantly improved the CR rate in nodal, but not in extranodal, lymphomas. Patients receiving R-CHOP showed higher OS than those treated with CHOP alone (5-year OS: 71% vs. 48%). This difference was maintained in primary nodal (5-year OS: 69% vs. 37%, p 5 0.0001), but was not observed in primary extranodal (75% vs. 65%, p ¼ 0.45) lymphomas. The IPI, treatment, and primary site were the main variables for OS in multivariate analysis. In nodal cases, IPI and treatment maintained value, whereas only IPI predicted OS in extranodal cases. In conclusion, immunochemotherapy treatment dramatically improved the outcome of patients with nodal DLBCL; however, its effect was less in primary extranodal cases, so the prognosis of patients with nodal and extranodal lymphomas has been equalized in the rituximab era.
Journal of Clinical Oncology, 2021
PURPOSE Lenalidomide combined with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (R2CHOP) in untreated diffuse large B-cell lymphoma (DLBCL) has shown promising activity, particularly in the activated B-cell–like (ABC) subtype. Eastern Cooperative Oncology Group (ECOG)-ACRIN trial E1412 was a randomized phase II study comparing R2CHOP versus R-CHOP in untreated DLBCL. PATIENTS AND METHODS Patients with newly diagnosed DLBCL, stage II bulky-IV disease, International Prognostic Index (IPI) ≥ 2, and ECOG performance status ≤ 2 were eligible and randomly assigned 1:1 to R2CHOP versus R-CHOP for six cycles. Tumors were analyzed using the NanoString Lymph2Cx for cell of origin. The primary end point was progression-free survival (PFS) in all patients with the co-primary end point of PFS in ABC-DLBCL. Secondary end points included overall response rate (ORR), complete response (CR) rate, and overall survival (OS). RESULTS Three hundred forty-nine patien...
Treatment strategies for aggressive lymphomas: what works?
Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, 2013
Over the past 30 years, many treatment platforms have been developed for diffuse large B-cell lymphoma, but none proved better than CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone/prednisolone). In the immunochemotherapy era, however, there is convincing evidence for superior chemotherapy platforms. A randomized study from the Groupe d'Etude des Lymphomes de l'Adulte showed that R-ACVBP (rituximab plus doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone) was superior to rituximab plus CHOP (R-CHOP) in patients under 60 years of age, but toxicity limits its use to younger patients. Studies also suggest that DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, rituximab) is more effective in some subtypes of diffuse large B-cell lymphoma and a randomized comparison with R-CHOP is now nearing completion. The simplicity and safety of R-CHOP and the long history of failed contenders, however, has set a high ...
Archives in Cancer Research
Diffuse large B-cell lymphoma (DLBCL) in the most common type of non-Hodgkin's lymphoma (NHL) in developed world, so far and approximately 60,000 new non-Hodgkin lymphoma (NHL) cases and 20,000 deaths have been estimated in the United States for 2010. In spite of novel therapeutic options have been suggested and successfully tried in patients with lymphoproliferative disorders, the standard first-line treatment for DLBCL has remained the same combination of chemotherapy and CD20 (activated-glycosylated phosphoprotein) targeting monoclonal antibody rituximab (R) with 30% to 40% chance of relapse after first line R-CHOP treatment. Several clinical trials have been designed to evaluate safety, efficacy and superior clinical benefit by adding novel agents, intensifying cycles of treatment or substituting rituximab with new CD20 targeting immunotherapies. Intensification of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) chemotherapy from 3-week interval cycles to 2-week interval cycles has already shown clinical benefit in a German trial but failed to show improved overall and disease free (DFS 1) survival in both elderly (60 to 80 years) and young patients in randomized phase 3 clinical trials. Namely, in a phase 2 randomized clinical trials (PYRAMID) as a first line treatment for non-Germinal Center Cell (GCB) subtype of DLBCL the results were in favor of R-CHOP and adding bortezomib was not found to improve DFS and OS significantly. Immunomodulatory agent lenalidomide is another attractive therapeutic option for non-GCB subtype of DLBCL. Statistically significant difference between non-GCB and GCB controls treated with standard R-CHOP alone in terms of progression-free survival (28% vs. 64%; P = 0.00029) and overall survival (46% vs. 74%; P = 0.000036) was reported while non-GCB and GCB treated with R-CHOP plus lenalidomide had similar rates of progression (60% vs. 59%; P = 0.83) and overall survival at 2 years (83% vs. 75%; P = 0.61). Despite these promising clinical results, further clinical studies, especially phase 3 randomized clinical trials are required to confirm the alternate competitive treatment for DLBCL patients.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015
Lenalidomide has significant single-agent activity in relapsed diffuse large B-cell lymphoma (DLBCL). We demonstrated that lenalidomide can be safely combined with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone); this new combination is known as R2CHOP. The goal of this phase II study was to evaluate the efficacy of this combination in newly diagnosed DLBCL. Eligible patients were adults with newly diagnosed untreated stages II to IV CD20(+) DLBCL. Patients received lenalidomide 25 mg orally per day on days 1 through 10 with standard-dose R-CHOP every 21 days for six cycles. All patients received pegfilgrastim on day 2 of each cycle and aspirin prophylaxis throughout. DLBCL molecular subtype was determined by tumor immunohistochemistry and classified as germinal center B-cell (GCB) versus non-GCB in the R2CHOP patients and 87 control patients with DLBCL from the Lymphoma Database who were treated with conventional R-CHOP. In all, 64 patients with D...