Prognostic features and outcome in patients with diffuse large B-cell lymphoma who do not achieve a complete response to first-line regimens

Citation
L. Villela et al., Prognostic features and outcome in patients with diffuse large B-cell lymphoma who do not achieve a complete response to first-line regimens, CANCER, 91(8), 2001, pp. 1557-1562
Citations number
32
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Oncology,"Onconogenesis & Cancer Research
Journal title
CANCER
ISSN journal
0008-543X → ACNP
Volume
91
Issue
8
Year of publication
2001
Pages
1557 - 1562
Database
ISI
SICI code
0008-543X(20010415)91:8<1557:PFAOIP>2.0.ZU;2-D
Abstract
BACKGROUND, The current study was conducted to analyze the outcome and prog nostic factors of patients with diffuse large B-cell lymphoma (DLCL) who di d not achieve a complete response (CR) to first-line treatment. METHODS, The current study was comprised of 83 patients (43 males and 40 fe males with a median age of 62 years) who did not achieve a CR (58 of whom h ad primary refractory disease and 25 of whom achieved a partial response) w ith initial treatment (doxorubicin-containing regimens in 87% of cases) fro m a series of 239 patients consecutively diagnosed with DLCL at a single in stitution. Initial variables, response to therapy, and salvage treatment we re analyzed to predict survival. RESULTS, Compared with patients who achieved a CR, nonresponders or partial responders more frequently were of advanced age and had a poor performance status (PS), B-symptoms, advanced stage of disease, bone marrow infiltrati on, increased serum lactate dehydrogenase, and a high-risk International Pr ognostic Index. Among the 58 patients with primary refractory disease, 18 d ied during initial treatment due to toxicity (14 patients) or disease progr ession (4 patients). The main variables predicting early death were a poor PS, age > 60 years, and an immunoblastic DLCL subtype. Twenty-five of these 58 patients were able to receive salvage regimens, with only 1 of them ach ieving a CR. The median survival for this group of patients was 10 months. With regard to those patients achieving a partial response, 18 of the 25 pa tients received further therapy with 28% of them achieving a CR. The median survival was 23 months. The degree of the response was found to be the onl y significant variable with which to predict survival, with 2-year survival rates of 4% and 40%, respectively, for patients with primary refractory di sease and patients who achieved a partial response. CONCLUSIONS. The prognosis of patients with primarily refractory DLCL is ex tremely unfavorable, whereas that of patients who achieve a partial respons e is slightly better. The inclusion of these patients in experimental trial s is limited due to their tendency to be of an older age and to have a poor general status. Cancer 2001;91:1557-62. (C) 2001 American Cancer Society.