title: Combination of rituximab with chemotherapy in diffuse large B-cell lymphoma. Evaluation in daily practice before and after approval of rituximab in this indication.
abstract: Randomized trials have demonstrated improved outcome from adding rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for patients with diffuse large B-cell lymphoma (DLBCL). This retrospective study compared the outcomes of 224 patients with DLBCL treated in our institution before (Period 1, 1996-2002) and after (Period 2, 2002-2005) approval of rituximab in this indication to evaluate the impact of the drug in daily practice in unselected patients receiving different types of chemotherapy. We treated 131 patients in Period 1 versus 93 in Period 2 (median follow-up, 75 and 29 months, respectively) with no difference in patient characteristics between the two periods. Event-free and overall survivals (EFS and OS) were significantly improved in Period 2 for elderly patients and a significant shift in the selection of regimens was observed at the time when rituximab became available. More patients received the CHOP regimen in Period 2 than in Period 1 (82 vs. 57%, p < 0.007) with CHOP being substituted for epirubicin-based regimens. In younger patients treated mostly with the ACVBP regimen (doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone) these differences were not observed, suggesting that combination of rituximab with dose-dense chemotherapy may deserve further evaluation in this age group.
authors.affiliation: Service d'Hématologie Clinique, Centre Léon Bérard, Lyon, France. ghesquie@lyon.fnclcc.fr
authors.forename: Hervé
authors.initials: H
authors.lastname: Ghesquières
authors.forename: Céline
authors.initials: C
authors.lastname: Ferlay
authors.forename: Catherine
authors.initials: C
authors.lastname: Sebban
authors.forename: Catherine
authors.initials: C
authors.lastname: Chassagne
authors.forename: Liana
authors.initials: L
authors.lastname: Carausu
authors.forename: Thérèse
authors.initials: T
authors.lastname: Gargi
authors.forename: Bertrand
authors.initials: B
authors.lastname: Favier
authors.forename: Irène
authors.initials: I
authors.lastname: Philip
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Pierre
authors.initials: P
authors.lastname: Biron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab