Diffuse Large B Cell Lymphoma: A Single Centre Study.

Anupam, Chakrapani (2011) Diffuse Large B Cell Lymphoma: A Single Centre Study. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND : Diffuse large B cell lymphoma (DLBCL) is a heterogeneous group of B-cell lymphoma with variation in patient survival. Information regarding clinical presentation, staging, prognostic determinant (biological [GCB, non-GCB] and clinical[IPI]), and response to chemotherapy (CHOP and Rituximab CHOP) in exclusively nodal cases of DLBCL is limited. AIMS AND OBJECTIVES: To analyse the response to chemotherapy (CHOP and Rituximab CHOP) and to access the prognostic significance of IPI and biological subgrouping of nodal DLBCL cases in our institution. METHODS : All patients with nodal DLBCL cases who underwent treatment with minimum six months follow up in the Department of Haematology between January 2006 and April 2010 and whose slides and blocks could be retrieved from Department of Pathology were included in the study. RESULTS: Of the 106 patients, 71(67%) male and 78(73.6%) patients were <60 years of age. 72(67.9%) presented with B-symptoms, 62(58.5%) had stage III/IV, and 80(75.5%) had high LDH at diagnosis. 22(20.8%) had one or more extra-nodal disease and 21(19.8%) had bulk disease. Out of 106 patients 66(62.2%) were in low IPI risk (0,1,2) and 40(37.7%) were in high IPI risk(3,4,5). Based on immune-histochemistry(Hanset.al) we classified 43(40.5%)patients as GCB DLBCL and 63(59.4%) as non-GCB DLBCL. The clinical characteristics of patients in sub groups were similar.The CR+CRu was 88% in Rituximab vs 70.9%% in non-Rituximab treated patients at the end of six cycles of chemotherapy (p=0.082). After a median follow up of 36 months (range:6-44months in RCHOP and 6-42 months in CHOP),the three year cumulative relapse free survival(RFS) and overall survival(OS) was 56.4% and 74.5% respectively in those who received CHOP chemotherapy. The addition of Rituximab improved the cumulative RFS and OS to 86.3% and 76.5% respectively, though the difference was not significant. Addition of Rituximab in high IPI risk group patients, improve EFS and OS at 24 months to 74.9% and 83.3% vs 19.8% and 41.5% in CHOP group(p=0.002). Rituximab treated patients in either GCB or non-GCB subgroup had similar EFS and cumulative RFS at median follow up of 24 months in comparison to non-Rituximab patients. In GCB group of patients the Rituximab significantly improves the OS (89.1%vs50.3%) at median follow up of 24 months (p=0.02). Neutropenia with or without fever was the most common chemotherapy related complication and was significantly more in RCHOP patients 68.6% vs 47.3% (p=0.032). CONCLUSION : This is the largest series of patients with DLBCL comprehensively evaluated and analyzed for outcome after treatment with CHOP and RCHOP. Patients were classified into low and high IPI risk group as well GCB and non-GCB origin of their disease. Addition of Rituximab has significant advantage in GCB and high IPI risk subgroups. In non-GCB and IPI low risk sub group, Rituximab increases relapse free survival but not the overall survival. Further analysis needs to be done with more number of patients and longer follow-up to truly understand the trend observed in this study for patients in India.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diffuse Large B Cell Lymphoma ; Single Centre Study.
Subjects: MEDICAL > Clinical Haematology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:41
Last Modified: 16 Aug 2017 04:16
URI: http://repository-tnmgrmu.ac.in/id/eprint/1799

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