Ganesan P, Sagar T G, Kannan K, Radhakrishnan V, Rajaraman S, John A, Sundersingh S, Mahajan V, Ganesan T S
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
Department of Cancer Registry Registry and Biostatistics, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
Indian J Cancer. 2017 Apr-Jun;54(2):430-435. doi: 10.4103/ijc.IJC_241_17.
Rituximab (R)-CHOP improves survival over CHOP in diffuse large B-cell lymphoma (DLBCL). The availability of biosimilar rituximab in India has increased access of this drug. We report on the impact of treatment on outcomes with special emphasis on the impact of biosimilar rituximab and radiation.
Outcomes of adults (age 15-60 years) treated with CHOP+/- Rituximab radiation were analyzed retrospectively to look at baseline features, treatment, and event-free and overall survival (EFS and OS).
In the period 2000-2013, 444 patients (median age 47 years: 15-60; males: 288 [65%]; Stage III/IV: 224 [50%]; age-adjusted international prognostic index [aaIPI] Score 2 or 3 in 50%) received either CHOP (n = 325 [73%]) or RCHOP (n = 119 [27%]) therapy. Biosimilar rituximab and the original were used in 95 (80%) and 24 (20%) patients, respectively. Radiation was given in 134 (30%) patients (Stages I and II, 100/220 [45%] and Stages III and IV, 34/224 [15%]). After a median follow-up of 46 (0.2-126) months, the 5-year EFS and OS were 59% and 68%, respectively. The factors predicting inferior EFS and OS were age> 40 years, performance status 2-4, Stage III/IV, hemoglobin <12 g/dL, the aaIPI Score 2 or 3, and nonuse of rituximab and radiation. Radiation used in early stage disease benefitted all subgroups regardless of bulky disease, use of rituximab, or the number of cycles of chemotherapy. Addition of rituximab improved survival across all categories of aaIPI.
Availability of biosimilar rituximab has increased access and survival of patients with DLBCL in India. Radiotherapy improved outcomes in early stages.
利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）方案相较于单纯环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）方案可提高弥漫性大B细胞淋巴瘤（DLBCL）患者的生存率。印度生物类似药利妥昔单抗的出现增加了该药物的可及性。我们报告了治疗对预后的影响，特别强调了生物类似药利妥昔单抗和放疗的影响。
回顾性分析接受CHOP±利妥昔单抗及放疗的15至60岁成人患者的预后情况，以观察基线特征、治疗情况以及无事件生存期和总生存期（EFS和OS）。
在2000年至2013年期间，444例患者（中位年龄47岁：15至60岁；男性：288例[65%]；Ⅲ/Ⅳ期：224例[50%]；年龄校正国际预后指数[aaIPI]评分为2或3的患者占50%）接受了CHOP方案（n = 325例[73%]）或R-CHOP方案（n = 119例[27%]）治疗。分别有95例（80%）和24例（20%）患者使用了生物类似药利妥昔单抗和原研药。134例（30%）患者接受了放疗（Ⅰ和Ⅱ期，100/220例[45%]；Ⅲ和Ⅳ期，34/224例[15%]）。中位随访46（0.2至126）个月后，5年EFS和OS分别为59%和68%。预测EFS和OS较差的因素包括年龄>40岁、体能状态2至4、Ⅲ/Ⅳ期、血红蛋白<12 g/dL、aaIPI评分为2或3以及未使用利妥昔单抗和放疗。早期疾病使用放疗对所有亚组均有益，无论肿块大小、是否使用利妥昔单抗或化疗周期数。添加利妥昔单抗可提高所有aaIPI类别患者的生存率。
生物类似药利妥昔单抗的可及性提高了印度DLBCL患者的可及性和生存率。放疗改善了早期患者的预后。
