title: Impact of inadequate doses of rituximab in the treatment of diffuse large B cell lymphoma in Malaysian patients.
abstract: BACKGROUND
  The current standard treatment for patients with newly diagnosed diffuse large B cell lymphoma (DLBCL) is rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP). A significant number of patients were not treated with recommended dose of rituximab due to limited financial resources in Malaysia. This study evaluates the efficacy of R-CHOP like chemotherapy in Malaysian patients with DLBCL.
  
  
  METHODS
  The study comprised a retrospective analysis of patients with DLBCL treated at a single centre. The outcome was compared with patients who were treated with R-CHOP like and CHOP like chemotherapy. Patients who were treated with lower dose of rituximab was subanalysed for outcome.
  
  
  RESULTS
  A total of 86 patients who had CHOP-like chemotherapy were included. Only 39 (45%) patients had rituximab and only 12 (29%) patients had the recommended dose. The overall response (OR) and complete response (CR) rates were 88% and 81% respectively. There was no significant difference in OR and CR in patients who had rituximab and those without rituxmab. Those with International Prognostic Index (IPI) score of ≤ 2 had significant higher CR rate, progression free survival (PFS) and overall survival (p<0.001).
  
  
  CONCLUSIONS
  The lack of significant improvement in CR and DFS in our patients may be due to an inadequate dose of rituximab.
authors.affiliation: Department of Medicine, Faculty of Medicine,University Malaya, Kuala Lumpur, Malaysia E-mail : gangg@ummc. edu.my.
authors.forename: Gin Gin
authors.initials: GG
authors.lastname: Gan
authors.forename: Rajaletchumy
authors.initials: R
authors.lastname: Subramaniam
authors.forename: Ping Chong
authors.initials: PC
authors.lastname: Bee
authors.forename: Edmund Fui Min
authors.initials: EF
authors.lastname: Chin
authors.forename: Habibah
authors.initials: H
authors.lastname: Abdul-Halim
authors.forename: Mei Chee
authors.initials: MC
authors.lastname: Tai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone