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Medientyp:
E-Artikel
Titel:
Chemotherapeutic intensity and survival differences in young patients with diffuse large B‐cell lymphoma: a Swedish Lymphoma Registry study
Beteiligte:
Melén, Christopher M.;
Enblad, Gunilla;
Sonnevi, Kristina;
Junlén, Henna Riikka;
Smedby, Karin E.;
Jerkeman, Mats;
Wahlin, Björn Engelbrekt
Beschreibung:
<jats:title>Summary</jats:title><jats:p>Young patients with diffuse large B‐cell lymphoma (<jats:styled-content style="fixed-case">DLBCL</jats:styled-content>) are variably treated with rituximab combined with cyclophosphamide‐doxorubicin‐vincristine‐prednisone (R‐<jats:styled-content style="fixed-case">CHOP</jats:styled-content>), <jats:styled-content style="fixed-case">CHOP</jats:styled-content>‐etoposide (R‐<jats:styled-content style="fixed-case">CHOEP</jats:styled-content>), and anthracycline‐based regimens with the addition of high‐dose cytarabine/methotrexate (R‐<jats:styled-content style="fixed-case">HDA</jats:styled-content>/M). Using the nationwide, population‐based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 <jats:styled-content style="fixed-case">DLBCL</jats:styled-content> 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 (aa<jats:styled-content style="fixed-case">IPI</jats:styled-content>) ≥ 2, the 5‐year overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>) was 70%, 76% and 85% after R‐<jats:styled-content style="fixed-case">CHOP</jats:styled-content>, R‐<jats:styled-content style="fixed-case">CHOEP</jats:styled-content> and R‐<jats:styled-content style="fixed-case">HDA</jats:styled-content>/M, respectively (<jats:italic>P</jats:italic> = 0·002); the corresponding estimates were 40%, 55%, and 92% in aa<jats:styled-content style="fixed-case">IPI</jats:styled-content> = 3 (<jats:italic>P</jats:italic> = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aa<jats:styled-content style="fixed-case">IPI</jats:styled-content> ≥ 2: three were “Moderate” (more R‐<jats:styled-content style="fixed-case">CHOP</jats:styled-content>) and three “Intensive” (more R‐<jats:styled-content style="fixed-case">CHOEP</jats:styled-content> and R‐<jats:styled-content style="fixed-case">HDA</jats:styled-content>/M). Patients with aa<jats:styled-content style="fixed-case">IPI</jats:styled-content> ≥ 2 who were treated in the Intensive Regions, showed better <jats:styled-content style="fixed-case">OS</jats:styled-content> (<jats:italic>P</jats:italic> < 0·00005), particularly those with aa<jats:styled-content style="fixed-case">IPI</jats:styled-content> = 3 (5‐year <jats:styled-content style="fixed-case">OS</jats:styled-content>, 62% vs. 30%; <jats:italic>P</jats:italic> < 0·00005). There were no regional differences in therapy or survival in patients with aa<jats:styled-content style="fixed-case">IPI</jats:styled-content> < 2. We conclude that in younger high‐risk patients, survival appears superior after more intensive therapy than R‐<jats:styled-content style="fixed-case">CHOP</jats:styled-content>.</jats:p>