Preliminary results of RCHOP in the treatment of DLBCL R. Tissir A.Quessar, M.Rachid, S. Benchekroun hematology and oncology department in 20 Août 1953 Hospital, university center IBN Rochd Casablanca Morocco

Background Diffuse large B-cell lymphoma (DLBCL) is the most commonly

occurring lymphoma in the Western world. It’s account for about one-third of all lymphomas in adults

DLBCLs are clinically, biologically, and pathologically heterogeneous with biologically distinct subtypes that have different expected treatment outcomes.

The rituximab has been registered in Europe since 1998. since the introduction of rituximab (RCHOP) in TTT of DLBCL a revolutionary improvement in treatment outcome was achieved, especially in the low risk group according to IPI.

In our unit the RCHOP become the standard of TTT since 2009

Treatment strategies for patients with diffuse large B-cell lymphoma: Blood and Lymphatic Cancer: Targets and Therapy 2012:2 87–98

Purpose

To analyze the outcome of patients with DLBCL treated

by RCHOP regimen in our unit

Patients and Methods Population:

- Newly diagnosed untreated patients with nodal DLBCL aged ≥18y, who received a minimal of 3 RCHOP21. during the period from Novembre 2009 until June 2011 (20months)

The diagnosis :

- on the basis of excisional lymph node or tissue biopsy according to WHO criteria 2008

- IHC : CD20, CD3, CD5, CD10, bcl2, bcl6, MUM1, Ki67

Staging comprised clinical examination, thoracic and abdominal computed tomography scans

Bone marrow biopsy

Patients and methods CBC,routine blood chemistry LDH, protein electrophoresis , renal and

liver function

Echocardiography in patient with a history of cardiac disease or older

Viral screening test : HVC,HVB,HIV

Prognostic factor according IPI , aaIPI

The response evaluation :abnormal radiological tests at baseline were repeated after 3to 4 cycles and after the last cycle of treatment, the bone marrow biopsy was repeated in the end of TTT if initially involved

The OS and EFS were performed by Kaplein Meyer method

Data were analyzed using Epi info system.

Patients and methods patients were excluded : - extranodal localisation, - less than 3 RCHOP - TTT CHOP

• Distribution of NHL per year

2004

2005

2006

2007

2008

2009

2010

janu

ary-

june

201

10

50

100

150

200

250

48%50%

45% 47% 46%47% 47%

52% NHLDLBCL

169 patients were assigned from Nov 2009 until june2011

- 83 nodal 49% : 12 CHOP 19 lost befor TTT 52 RCHOP - 86 extranodal

31%

15%8%

3%

8%

10%

10%

3% 9%

2% 2%

extranodal localizationgastric colon+grelecerebralorbite,annexegynecologiccutaneousmediastinlungbonethyroidpartie molle

Geographic distribution

33%

29%8%

30%

North region south region unspecified casablanca

Epidemiological characteristics

Patients included 52

Mean age 52,3 years (range 25-77 y)

Sex-ratio M/F 1.2

•

Distribution by age and sex group :

25-30 30-40 40-50 50-60 ≥60 years

0

5

10

15

20

25

femalmal

62%58%

Clinical features

the mean delay of diagnosis

6 months (range 1-12)

B symptoms 30 patients (58%)

HVC + 4 patients (8%)

venous thrombosis at diagnosis .

1 patient (2%)

Localization

Sites Nb %

Lymph nods 40 77%

Tonsil 10 19%

Cavum 2 4%

Ann –Arbor staging :

Stage Nb %

I 8 15%

II 18 35%

III 20 38%

IV 6 12%

Score IPI

IPI Risk Nb %

0 Low risk 15 29%

1 Low intermediate 14 27%

2 Hight intermediate 18 34%

> 2 Hight risk 5 10%

Treatment - the mean delay before treatment : 26 days

(1-120) - the mean nb of RCHOP : 6 cycles (3-8 )

Treatment

52 pts

1 death under TTT

(2%)

46 CR(88%)

9 relapses (17%)

3 under TTT 6 deaths

37 CR(71%)

1 death lung

fibrosis

36 MCR(69%)

5 failure (10%)

2 deaths after

RDHAP

3 deaths after

failure

Failure , death and relapses charactéristics:

Response

Age Sex-ratio

Stage IPI Remarks

Death 65 M IIIA unfavorable

Comorbidities

Faillure 3/5 <60y

h/f 0.7 3/5 advanced stage

3/5 unfavorable

2 HVC +

Relapses

5/9 ≥60 Y

0.6 7 advanced stage

7 unfavorable

69%

<60 ans: 75%

≥60 ans : 60%

59%

<60 years old :73%

≥60 years old : 39%

88%

48%

83%

31%

Conclusion The DLBCL is the most common subtype of NHL in

our unit approximatively 50% of all lymphomas.

The mean age at diagnosis is 52 y , pic incidence in younger patients.

44 % of patients with unfavorable IPI

Good response in younger patients Vs elderly patients Relapases are more frequent in : elderly patients,

advanced stage and unfavorabl IPI.

Conclusion Gene expressing profiling Intensive therapy with ASCT for advanced

stage and refractory disease improve the supportive care PET scan is available but not accessible for

all patients We should focus on decreasing the relapse

rate without increasing toxicity in elderly patients.

The interest of a codified protocol