Gogia Ajay, Das Chandan K, Kumar Lalit, Sharma Atul, Tiwari Akash, Sharma M C, Mallick Soumya
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
South Asian J Cancer. 2018 Jul-Sep;7(3):200-202. doi: 10.4103/sajc.sajc_65_18.
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin's lymphoma. We conducted a retrospective study to analyze the clinicopathological characteristics, cell of origin, response to therapy, and the outcome of patients with DLBCL.
This was a retrospective study which included all patients with DLBCL registered at our center, between May 1, 2013, and July 31, 2015. The data regarding demography, clinical presentation, histopathology, stage, prognostic index, treatment, and treatment-related outcome were collected from prospectively maintained clinical case records of the patients.
In the study, we included 267 patients. The median age is 49 (20-81) years with male: female ratio of 2:1. B symptoms were seen in 124 (45%) of patients. Early Stages (I and II) were seen in 130 (52%) patients, while advanced Stages (III and 1V) were seen in 119 (48%) patients. Bulky disease (>7.5 cm) was seen in 30% of cases, and bone marrow was involved in 12%. Extranodal involvement is present in 35% of cases. Cell of origin data was available in 160 (60%) of cases, of which 88 (55%) were germinal center and 72 (45%) were activated B cell in origin. The distribution according to the international prognostic index (IPI) was as follows: low risk 40%, intermediate risk 45%, and high risk in 15%. Rituximab was used in 45% of cases. The overall response rate was 84% with a complete response (CR) rate of 70.5%. The CR rates were better with RCHOP compared with CHOP (77% vs. 61.5%, = 0.001) and good-risk IPI (83.3% vs. 65.2%, < 0.001) compared with intermediate- and high-risk IPI. Median follow-up period was 24 months, and 2-year event-free survival (EFS) was 70%. The presence of B symptoms, high IPI, failure to attain CR, poor PS, and nonrituximab-based chemotherapy were significantly associated with lower EFS.
This is the first study from India, which investigated the impact of chemotherapy with or without rituximab in context of cell of origin. Adding rituximab to CHOP showed better response rate and EFS irrespective of cell of origin.
弥漫性大B细胞淋巴瘤（DLBCL）是非霍奇金淋巴瘤最常见的亚型。我们进行了一项回顾性研究，以分析DLBCL患者的临床病理特征、起源细胞、对治疗的反应及预后。
这是一项回顾性研究，纳入了2013年5月1日至2015年7月31日在本中心登记的所有DLBCL患者。从患者前瞻性维护的临床病例记录中收集有关人口统计学、临床表现、组织病理学、分期、预后指数、治疗及治疗相关结果的数据。
本研究纳入267例患者。中位年龄为49（20 - 81）岁，男女比例为2:1。124例（45%）患者出现B症状。130例（52%）患者为早期阶段（I和II期），119例（48%）患者为晚期阶段（III和IV期）。30%的病例出现大包块病变（>7.5 cm），12%的病例累及骨髓。35%的病例存在结外受累。160例（60%）病例可获得起源细胞数据，其中88例（55%）起源于生发中心，72例（45%）起源于活化B细胞。根据国际预后指数（IPI）的分布如下：低危40%，中危45%，高危15%。45%的病例使用了利妥昔单抗。总缓解率为84%，完全缓解（CR）率为70.5%。与CHOP方案相比，RCHOP方案的CR率更高（77%对61.5%，P = 0.001），与中高危IPI相比，低危IPI的CR率更高（83.3%对65.2%，P < 0.001）。中位随访期为24个月，2年无事件生存率（EFS）为70%。B症状的存在、高IPI、未达到CR、较差的体能状态及非利妥昔单抗为基础的化疗与较低的EFS显著相关。
这是来自印度的第一项研究，在起源细胞背景下研究了含或不含利妥昔单抗化疗的影响。无论起源细胞如何，在CHOP方案中添加利妥昔单抗均显示出更好的缓解率和EFS。
