Introduction of Combined CHOP Plus Rituximab Therapy Dramatically Improved Outcome of Diffuse Large B-Cell Lymphoma in British Columbia

• Published in: Journal of clinical oncology Vol. 23; no. 22; pp. 5027 - 5033
• Main Authors: SEHN, Laurie H, DONALDSON, Jane, WILSON, Kenneth S, GASCOYNE, Randy D, CONNORS, Joseph M, CHHANABHAI, Mukesh, FITZGERALD, Catherine, GILL, Karamjit, KLASA, Richard, MACPHERSON, Nicol, O'REILLY, Susan, SPINELLI, John J, SUTHERLAND, Judy
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.08.2005; Lippincott Williams & Wilkins
• Subjects: Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Murine-Derived; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; British Columbia; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Female; Humans; Lymphoma, B-Cell - drug therapy; Lymphoma, B-Cell - pathology; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - pathology; Male; Medical sciences; Middle Aged; Neoplasm Staging; Pharmacology. Drug treatments; Prednisone - administration & dosage; Prognosis; Retrospective Studies; Rituximab; Treatment Outcome; Tumors; Vincristine - administration & dosage; Canada; British Columbia; North America; America; Antineoplastic agent; Prognosis; Monoclonal antibody; Doxorubicin; Alkaloid; Isomerases; Cancerology; Lymphoproliferative syndrome; Immunotherapy; Anticytokine; Antimitotic; Human; DNA topoisomerase (ATP-hydrolysing); Enzyme; Enzyme inhibitor; Rituximab; Malignant hemopathy; B-Lymphocyte; Large cell lymphoma; Prednisone; Non Hodgkin lymphoma; Vincristine; Alkylating agent; Chemotherapy; Cyclophosphamide; Oxazaphosphinane derivatives; Nitrogen mustard; CHOP regimen; Anthracyclins; Combined treatment
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2005.09.137

For more than two decades, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has been the standard therapy for diffuse large B-cell lymphoma (DLBCL). The addition of rituximab to CHOP has been shown to improve outcome in elderly patients with DLBCL. We conducted a population-based analysis to assess the impact of this combination therapy on adult patients with DLBCL in the province of British Columbia (BC). We compared outcomes during a 3-year period; 18 months before (prerituximab) and 18 months after (postrituximab) institution of a policy recommending the combination of CHOP and rituximab for all patients with newly diagnosed advanced-stage (stage III or IV or stage I or II with "B" symptoms or bulky [> 10 cm] disease) DLBCL. A total of 292 patients were evaluated; 140 in the prerituximab group (median follow-up, 42 months) and 152 in the postrituximab group (median follow-up, 24 months). Both progression-free survival (risk ratio, 0.56; 95% CI, 0.39 to 0.81; P = .002) and overall survival (risk ratio, 0.40; 95% CI, 0.27 to 0.61, P < .0001) were significantly improved in the postrituximab group. After controlling for age and International Prognostic Index score, era of treatment remained a strong independent predictor of progression-free survival (risk ratio, 0.59; 95% CI, 0.41 to 0.85; P = .005) and overall survival (risk ratio, 0.43; 95% CI, 0.29 to 0.66; P < .001). The benefit of treatment in the postrituximab era was present regardless of age. The addition of rituximab to CHOP chemotherapy has resulted in a dramatic improvement in outcome for DLBCL patients of all ages in the province of BC.