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

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

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 60years 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=0002); the corresponding estimates were 40%, 55%, and 92% in aaIPI=3 (P=0014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI2: three were Moderate (more R-CHOP) and three Intensive (more R-CHOEP and R-HDA/M). Patients with aaIPI2 who were treated in the Intensive Regions, showed better OS (P<000005), particularly those with aaIPI=3 (5-year OS, 62% vs. 30%; P<000005). 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.

Enblad, GunillaUppsala universitet,Experimentell och klinisk onkologi,Uppsala University Hospital(Swepub:uu)gunienbl (author)
Sonnevi, KristinaKarolinska Institutet (author)
Junlen, Henna RiikkaKarolinska Institutet (author)
Smedby, Karin E.Karolinska Institutet (author)
Jerkeman, MatsLund University,Lunds universitet,Tumörmikromiljö,Sektion I,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Tumor microenvironment,Section I,Department of Clinical Sciences, Lund,Faculty of Medicine(Swepub:lu)onk-mje (author)
Wahlin, Björn EngelbrektKarolinska Institutet (author)
Karolinska InstitutetExperimentell och klinisk onkologi (creator_code:org_t)

By the author/editor: Melén, Christoph ...; Enblad, Gunilla; Sonnevi, Kristin ...; Junlen, Henna Ri ...; Smedby, Karin E.; Jerkeman, Mats; show more...; Wahlin, Björn En ...; show less...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Hematology

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cancer and Oncol ...

By the university: Uppsala University; Lund University; Karolinska Institutet

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