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Moscow State UniversityFaculty of Basic Medicine
CHOP CHEMOTHERAPY PLUS RITUXIMAB COMPARED WITH CHOP ALONE IN ELDERY PATIENTS WITH DIFFUSE
LARGE B CELL LYMPHOMAPresented by Dr.Chan Myae Htut (M.B.B.S)
Supervisors – Prof Dr. B.I.Polyakov,Dr.D.A.Bykov
May 19,2010
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INTRODUCTION Lymphoma – cancer of the lymphatic system. Two types
- Hodgkin’s lymphoma (HL)- Non Hodgkin’s lymphoma (NHL)
DLBCL NHL DLBCL heterogenous group of aggressive
lymphoma of large transformed B cells. 30% of all NHL Middle-aged and older person Median age at diagnosis – 64 yrs Men > Women
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ETIOLOGY AND PATHOGENESIS No apparent etiology
Risk factors
- personal & family history of NHL
- primary immunosuppression
- autoimmune disorders
- organ transplantation
- occupational exposures to toxins
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CLINICAL FEATURES Typical presentation rapidly enlarging lymph node or an
abdominal mass
B symptoms - 30%
- drenching night sweats
- fever
-weight loss
Extra nodal presentation GIT, bone, thyroid,
skin, breast, live, nasal cavity, salivary glands, CNS
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DIAGNOSIS Lymph node biopsy
Imaging studies
Bone marrow tests
Lumber puncture
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Therapy(In patients older than 60 years) Standard CHOP C - cyclophosphamide ( 750 mg/m2 on day 1 ) H- doxorubicin ( 50 mg/m2 on day 1 ) O- vincristine ( 1.4-2 mg/m2 on day 1 ) P- prednisone ( 40 mg/m2 for 5 days ) every 3 weeks for 8 cycles Another R-CHOP R-rituximab anti CD-20 monoclonal antibody
( 375 mg/m2 on day 1 )
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AIM OF STUDY To identify the advantages of usage of
monoclonal antibody (Rituximab) with
standard chemotherapeutic agents in
patients with diffuse large B cell lymphoma
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OBJECTIVE OF STUDY1) To identify the prognostic significance of
diffuse large B cell lymphoma patients by
the treatment of R-CHOP and CHOP alone
2) To determine the significance of drug
toxicities of R-CHOP and CHOP
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DESIGN OF STUDY
52 PATIENTS
27 PATIENTSR-CHOP
25 PATIENTSCHOP
27 PATIENTSR-CHOP
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MAIN CHARACTERISTICS OF PATIENTS (N=52)CHARACTERISTICS R-CHOP (N=27)
NO(%)CHOP (N=25)
NO(%)
Age<65 yrs65 – 69 yrs70 -74 yrs> 74 yrs
6 (22)8 (28)7 (26)6 (22)
6 (24)8 (31)7 (28) 4 (16)
Male Sex 12 (46) 16 (54)
Performance Status01> 1
9 (33)12 (45)6 (22)
9 (36)12 (48)4 (17)
B symptoms 11 (39) 9 (36)
StageIIIIIIIV
0 5 (20)4 (16)18 (63)
05 (20)4 (15)
16 (65)
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MAIN CHARACTERISTICS OF PATIENTS (N=52) (Contd.)
CHARACTERISTICS R-CHOP (N=27)NO(%)
CHOP (N=25)NO (%)
No of extra nodal sites01>2
6 (23)13 (47)8 (30)
6 (22)12 (52)7 (26)
Bulky tumour (>10cm) 8 (30) 8 (32)
Bone marrow involvement 8 (30) 7 (28)
Standard International PrognosticIndex Score0-1234-5
4 (16)9 (32)
11 (39)3 (15)
3 (12)9 (35)10 (42)3 (12)
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RESPONSE TO TREATMENT
RESPONSE R-CHOP (N=27)
NO(%)
CHOP (N=25)
NO(%)
Complete response
Unconfirmed complete
response
Partial response
Progressive disease
Death without progression
14 (52)
6 (23)
2 (7)
3 (9)
2 (6)
9 (37)
7 (26)
2 (6)
5 (22)
2 (1)
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EVENT FREE SURVIVAL
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OVERALL SURVIVAL
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NONHEMATOLOGIC ADVERSE EVENTS
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NONHEMATOLOGIC ADVERSE EVENTS(Contd.)
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DISCUSSION Higher response rates and improved event-free and overall
survival among patients treated with the combination of
rituximab and CHOP
Longer survival in the CHOP-plus-rituximab group was due to
lower rate of disease progression during therapy and fewer
relapses among patients who had a complete response
Treatment with CHOP plus rituximab was well tolerated, and
the incidence of severe or serious adverse events was no different
from that in the CHOP group
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CONCLUSION The addition of rituximab to CHOP chemotherapy, given
for eight cycles to eldery patients with newly diagnosed
diffuse large B cell lymphoma, significantly increase the
rate of complete response, decrease the rates of treatment
failure and relapse, and improves event-free and overall
survival as compared with standard CHOP alone.
These gains were achieved without a significant increase in
clinically significant toxic effects.
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