Phase II study of CHOP-GR therapy in diffuse large B-cell lymphoma

Department of Internal Medicine, Yokohama Ekisaikai Hospital, Yokohama, Japan.
International journal of hematology (Impact Factor: 1.92). 06/2012; 96(2):241-6. DOI: 10.1007/s12185-012-1119-5
Source: PubMed


We investigated a fixed scheme of combination chemotherapy protocol including CHOP, granulocyte colony stimulating factor (G-CSF) and rituximab (CHOP-GR) for patients with diffuse large B cell lymphoma (DLBCL) in a phase II clinical trial. Forty-four patients were registered: 21 patients <61 years of age in the low or low-intermediate International Prognostic Index (IPI) risk group and 23 patients between 61 and 70 years of age in any IPI risk group. The patients underwent two courses of CHOP chemotherapy followed by four courses of CHOP-GR, including subcutaneous G-CSF on days 11-14 and rituximab on day 15. An additional two courses of weekly rituximab were administered. Of the assessable 43 patients, complete remission occurred in 39 (91 %), partial remission in one (2 %), and progressive disease in three (7 %). In the median 53-month observation period in alive patients, the 5-year overall survival rate of the 43 patients was 77 % and the 5-year progression-free survival rate was 69 % with a subsequent plateau. There were nine deaths in the 43 patients, all of which were attributable to lymphoma progression. The most frequent adverse events were leukocytopenia (98 %), neutropenia (94 %), lymphocytopenia (91 %), and alopecia (83 %). CHOP-GR is a safe and effective therapy for patients with untreated DLBCL.

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    ABSTRACT: We retrospectively analyzed the prognosis of patients with diffuse large B cell lymphoma (DLBCL) and a bulky mass at diagnosis. We retrospectively analyzed clinical data for 29 consecutive DLBCL patients with an initial bulky mass receiving R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) therapy from 2004 to 2011. Bulky disease was defined as a measurable tumor mass >10 cm in diameter or a mediastinal mass >1/3 of the chest diameter. Patients with primary mediastinal large B-cell lymphoma were excluded. The median age was 65 years (20–78 years) and the maximum tumor diameter was 11.5 cm (10.0–17.0 cm). Complete response and partial response were achieved in 14 patients each, while 1 patient had progressive disease. The 3-year overall survival (OS) rate and progression-free survival (PFS) rate were 66 and 56 %, respectively. Findings on post-treatment positron emission tomography-computed tomography (PET–CT) were significantly associated with OS (34 % for patients with abnormal uptake vs. 75 % for those without, P = 0.014), and were also associated with PFS (36 vs. 83 %, respectively, P DLBCL. However, the post-treatment PET–CT findings may have predictive value in DLBCL patients with a bulky mass.
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