Real-World Data on Rituximab Plus CHOP in DLBCL Indicate That "Excellent Outcomes" Are Possible

Treatment with rituximab plus a regimen of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) for patients with diffuse large B-cell lymphoma (DLBCL) has proven efficacy in clinical trials; however, few long-term data are available for the use of this combination in patients in a real-world setting.

A study newly published in Oncology Letters presents real-world experience with rituximab plus CHOP in a single-center retrospective database analysis. Between 2004 and 2013, 624 patients with DLBCL were treated at the Institute of Oncology in Ljubljana, Slovenia. All patients received first-line chemotherapy, and the 607 patients whose tumors were CD20-positive (n = 575) received rituximab with their CHOP or CHOP-like chemotherapy regimens. Another 32 patients received a different non-anthracycline chemotherapy regimen in combination with rituximab, and 17 patients received chemotherapy alone.

A total of 136 patients (22%) received second-line therapy, and 56 patients (9%) received third-line therapy. According to the IPI risk category system, 170 patients (30%) were considered low- risk, 134 (23%) were low/intermediate-risk, 129 (23%) were high/intermediate-risk, and 140 (24%) were high-risk.

The researchers determined progression-free survival (PFS) only among patients undergoing first-line treatment, and found an overall 10-year PFS of 72%. The following percentages of patients were progression-free at 10 years after treatment:

• 75% of low-risk patients
• 75% of low/intermediate-risk patients
• 64% of high/intermediate-risk patients
• 71% of high-risk patients

Overall survival (OS) was assessed for all patients, and the researchers observed a 10-year OS rate of 51% in the overall population. Median OS was 124 months in the overall population, and the percentages of patients who were alive at 10 years after treatment were as follows:

• 80% of low-risk patients
• 60% of low/intermediate-risk patients
• 43% of high/intermediate risk patients
• 30% of high-risk patients

There was a statistically significant difference in OS between younger patients (aged 60 years or under) with a good prognosis versus those with a poor prognosis, with 10-year OS rates of 87% and 67%, respectively. “Younger, high-risk patients clearly represent a population for whom better treatment options are needed,” say the authors.

The authors conclude that rituximab plus CHOP or CHOP-like regimens in patients with DLBCL in the real-world setting can have “excellent outcomes,” but they stress the importance of accurate disease staging to confidently assign prognostic scores and assess likely outcomes for these patients.

Reference

Horvat M, Zadnik V, Šetina TJ, et al. Diffuse large B-cell lymphoma: 10 years’ real-world clinical experience with reituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone [published online January 11, 2018]. Oncol Lett. doi: 10.3892/ol.2018.7774.