Moscow State UniversityFaculty of Basic Medicine

CHOP CHEMOTHERAPY PLUS RITUXIMAB COMPARED WITH CHOP ALONE IN ELDERY PATIENTS WITH DIFFUSE

LARGE B CELL LYMPHOMAPresented by Dr.Chan Myae Htut (M.B.B.S)

Supervisors – Prof Dr. B.I.Polyakov,Dr.D.A.Bykov

May 19,2010

INTRODUCTION Lymphoma – cancer of the lymphatic system. Two types

- Hodgkin’s lymphoma (HL)- Non Hodgkin’s lymphoma (NHL)

DLBCL NHL DLBCL heterogenous group of aggressive

lymphoma of large transformed B cells. 30% of all NHL Middle-aged and older person Median age at diagnosis – 64 yrs Men > Women

ETIOLOGY AND PATHOGENESIS No apparent etiology

Risk factors

- personal & family history of NHL

- primary immunosuppression

- autoimmune disorders

- organ transplantation

- occupational exposures to toxins

CLINICAL FEATURES Typical presentation rapidly enlarging lymph node or an

abdominal mass

B symptoms - 30%

- drenching night sweats

- fever

-weight loss

Extra nodal presentation GIT, bone, thyroid,

skin, breast, live, nasal cavity, salivary glands, CNS

DIAGNOSIS Lymph node biopsy

Imaging studies

Bone marrow tests

Lumber puncture

Therapy(In patients older than 60 years) Standard CHOP C - cyclophosphamide ( 750 mg/m2 on day 1 ) H- doxorubicin ( 50 mg/m2 on day 1 ) O- vincristine ( 1.4-2 mg/m2 on day 1 ) P- prednisone ( 40 mg/m2 for 5 days ) every 3 weeks for 8 cycles Another R-CHOP R-rituximab anti CD-20 monoclonal antibody

( 375 mg/m2 on day 1 )

AIM OF STUDY To identify the advantages of usage of

monoclonal antibody (Rituximab) with

standard chemotherapeutic agents in

patients with diffuse large B cell lymphoma

OBJECTIVE OF STUDY1) To identify the prognostic significance of

diffuse large B cell lymphoma patients by

the treatment of R-CHOP and CHOP alone

2) To determine the significance of drug

toxicities of R-CHOP and CHOP

DESIGN OF STUDY

52 PATIENTS

27 PATIENTSR-CHOP

25 PATIENTSCHOP

27 PATIENTSR-CHOP

MAIN CHARACTERISTICS OF PATIENTS (N=52)CHARACTERISTICS R-CHOP (N=27)

NO(%)CHOP (N=25)

NO(%)

Age<65 yrs65 – 69 yrs70 -74 yrs> 74 yrs

6 (22)8 (28)7 (26)6 (22)

6 (24)8 (31)7 (28) 4 (16)

Male Sex 12 (46) 16 (54)

Performance Status01> 1

9 (33)12 (45)6 (22)

9 (36)12 (48)4 (17)

B symptoms 11 (39) 9 (36)

StageIIIIIIIV

0 5 (20)4 (16)18 (63)

05 (20)4 (15)

16 (65)

MAIN CHARACTERISTICS OF PATIENTS (N=52) (Contd.)

CHARACTERISTICS R-CHOP (N=27)NO(%)

CHOP (N=25)NO (%)

No of extra nodal sites01>2

6 (23)13 (47)8 (30)

6 (22)12 (52)7 (26)

Bulky tumour (>10cm) 8 (30) 8 (32)

Bone marrow involvement 8 (30) 7 (28)

Standard International PrognosticIndex Score0-1234-5

4 (16)9 (32)

11 (39)3 (15)

3 (12)9 (35)10 (42)3 (12)

RESPONSE TO TREATMENT

RESPONSE R-CHOP (N=27)

NO(%)

CHOP (N=25)

NO(%)

Complete response

Unconfirmed complete

response

Partial response

Progressive disease

Death without progression

14 (52)

6 (23)

2 (7)

3 (9)

2 (6)

9 (37)

7 (26)

2 (6)

5 (22)

2 (1)

EVENT FREE SURVIVAL

OVERALL SURVIVAL

NONHEMATOLOGIC ADVERSE EVENTS

NONHEMATOLOGIC ADVERSE EVENTS(Contd.)

DISCUSSION Higher response rates and improved event-free and overall

survival among patients treated with the combination of

rituximab and CHOP

Longer survival in the CHOP-plus-rituximab group was due to

lower rate of disease progression during therapy and fewer

relapses among patients who had a complete response

Treatment with CHOP plus rituximab was well tolerated, and

the incidence of severe or serious adverse events was no different

from that in the CHOP group

CONCLUSION The addition of rituximab to CHOP chemotherapy, given

for eight cycles to eldery patients with newly diagnosed

diffuse large B cell lymphoma, significantly increase the

rate of complete response, decrease the rates of treatment

failure and relapse, and improves event-free and overall

survival as compared with standard CHOP alone.

These gains were achieved without a significant increase in

clinically significant toxic effects.