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

• Published in: British journal of haematology Vol. 175; no. 4; pp. 614 - 622
• Main Authors: Melén, Christopher M., Enblad, Gunilla, Sonnevi, Kristina, Junlén, Henna Riikka, Smedby, Karin E., Jerkeman, Mats, Wahlin, Björn Engelbrekt
• Format: Journal Article
• Language: English
• Published: England 01.11.2016
• Subjects: aaIPI; Adolescent; Adult; Age Factors; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers; Cancer and Oncology; Cancer och onkologi; Clinical Medicine; cytarabine; Diffuse large B-cell lymphoma; Female; Humans; intensive chemotherapy; Klinisk medicin; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - epidemiology; Lymphoma, Large B-Cell, Diffuse - mortality; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Neoplasm Staging; Registries; Risk Factors; Survival Analysis; Sweden - epidemiology; Treatment Outcome; young; Young Adult; cytarabine; intensive chemotherapy; young; aaIPI; Diffuse large B-cell lymphoma
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/bjh.14399

Summary 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.