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.
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