title: Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma: a Swedish Lymphoma Registry study.
abstract: Young patients with diffuse large B-cell lymphoma (DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP), CHOP-etoposide (R-CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R-HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aaIPI) ≥ 2, the 5-year overall survival (OS) was 70%, 76% and 85% after R-CHOP, R-CHOEP and R-HDA/M, respectively (P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aaIPI = 3 (P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aaIPI ≥ 2: three were "Moderate" (more R-CHOP) and three "Intensive" (more R-CHOEP and R-HDA/M). Patients with aaIPI ≥ 2 who were treated in the Intensive Regions, showed better OS (P < 0·00005), particularly those with aaIPI = 3 (5-year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aaIPI < 2. We conclude that in younger high-risk patients, survival appears superior after more intensive therapy than R-CHOP.
authors: Division of Haematology, Department of Medicine, Huddinge, Sweden.|Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden.
authors: Christopher M
authors: CM
authors: Melén
authors: Department of Oncology, Uppsala University Hospital, Uppsala, Sweden.
authors: Gunilla
authors: G
authors: Enblad
authors: Division of Haematology, Department of Medicine, Huddinge, Sweden.|Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden.
authors: Kristina
authors: K
authors: Sonnevi
authors: Division of Haematology, Department of Medicine, Huddinge, Sweden.|Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden.
authors: Henna Riikka
authors: HR
authors: Junlén
authors: Unit of Clinical Epidemiology, Department of Medicine, Solna, Sweden.
authors: Karin E
authors: KE
authors: Smedby
authors: Department of Oncology, Lund University Hospital, Lund, Sweden.
authors: Mats
authors: M
authors: Jerkeman
authors: Division of Haematology, Department of Medicine, Huddinge, Sweden.|Karolinska Institutet, and Haematology Centre, Karolinska University Hospital, Stockholm, Sweden.
authors: Björn Engelbrekt
authors: BE
authors: Wahlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Diffuse large B-cell lymphoma; aaIPI; cytarabine; intensive chemotherapy; young