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Therapeutic results of diffuse large B- Cell lymphoma N.Ait Amer; F.Tensaout; H.Moussaoui; F.Belhadri; N.Abdennebi; F.Boukhamia; D.Benali; L.Metidji; S.Zeghouati;

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Presentation on theme: "Therapeutic results of diffuse large B- Cell lymphoma N.Ait Amer; F.Tensaout; H.Moussaoui; F.Belhadri; N.Abdennebi; F.Boukhamia; D.Benali; L.Metidji; S.Zeghouati;"— Presentation transcript:

1 Therapeutic results of diffuse large B- Cell lymphoma N.Ait Amer; F.Tensaout; H.Moussaoui; F.Belhadri; N.Abdennebi; F.Boukhamia; D.Benali; L.Metidji; S.Zeghouati; S.Zerkout; N.Boudjerra;R.M.Hamladji; Service dHématologie- Greffe de moelle osseuse Centre Pierre et Marie Curie

2 Introduction Diffuse large B-Cell lymphoma (LDGCB) represents approximately 40% of all lymphomas and 80% of aggressive lymphomas According to the Ann Arbor classification, the localized stage (clinical stages I/II) represent 35% to 45% of cases and advanced stage (clinical stages III/IV) 55% to 65% of cases(Hématologie 2007;13(5):320-3). The possibility of treating patients is based on a very precise stading of the disease and a deep investigation of the individual pronostic factors.

3 Materials and Methods (1) Between the 228 patients (pts) diagnosed as LDGCB from January 2001 to december 2010; we report the out come of 196 pts treated by CHOP with the advent of Rituximab (R) or not; followed or not by radiotherapy as first line treatment. Are excluded from the study all the cerebral lymphomas, the primary mediastinal lymphomas and the bones lymphomas. For the 196 pts of this study: -The median age is 57 years (16-83) -The sex ratio= 1,3 (111M/85F) -The median time to diagnosis : 5 months (0-48)

4 Materials and Methods (2) Clinical Staging: StagesNumber% I (49%) II 7036 III (51%) IV 4523 Bulky disease (large tumour size 7 cm) Localized stages(96) 3739 Advanced stages (100) 48

5 Materials and Methods (3) International pronostic index: has been determined in only 149/196 pts IPINumber% Low risk 5638 Good pronostic (67%) Low- intermediate risk 4429 High intermediate risk 3826 Poor pronostic (33%) High risk 117

6 Materials and Methods (4) The CHOP regimen is the combination of 750 mg/m² of Cyclophosphamide on day 1; 50 mg/m² of doxorubicin on day 1; 1,4 mg/m² of vincristine, up to a maximal dose of 2 mg on day 1; and 40 mg/m² of prednisone per day for five days. Advent or not Rituximab at a dose of 375 mg/m² on the day one of each CHOP cycle; with an average of 4 cycles of CHOP (1-8); every 3 weeks. The radiotherapy was given on the lymph-node regions involved at a dose of 40 Gy. At december 2011, the median follow up is 60 months (12 at 132) Therapy (1)

7 Advanced stage: 100 pts -59 pts received CHOP olone -41 pts received R-CHOP -28 pts among them; who are in first response after the first line therapy (CHOP ± R) underwent intensive regimens (27 pts have a high dose therapy followed by autologous stem cell transplantation [ASCT]; and 1 pt has an allogenic stem cell transplantation with a previous reduce conditionning regimen). Localized stage : 96 pts -58 pts received CHOP ± R+RT -38 pts received CHOP ± R (6pts underwent ASCT) Materials and Methods (5) Therapy (2)

8 Results (1) Advanced Stage: 100 pts First results : CHOP (59pts) R-CHOP (41pts) P CR 35 (59%)17 (42%)P=1,63 NS RP 05 (09%)12 (29%)/ Overall remission 40 (68%)29 (71%)P=0,76 NS Failures 10 (17%)10 (24%)/ Dead related to treatment Toxicity (TRM) 09 (15%)02 (05%)/

9 Results(2) Advanced stage 72/100 pts (28pts have been intensified ) Out come of their response CHOP (29pts) R-CHOP (12pts) Persistant response08 (28%)03 (25%) Relapse13 (45%)05 (42%) Death (CR)02 (07%)04 (33%) Losing sight pts (CR)06 (20%)/

10 Results (3) Out come of the advanced stage: 72 Pts Alives CHOP : 12 (25%) R-CHOP: 08 (33%) Death CHOP: 30(63%) R-CHOP: 16(66%) Losing sight pts CHOP 48pts 1st CR2nd CR Relapse Failure 1st CR RelapsefailureToxicity R-CHOP 24pts

11 EFS Advanced stage

12 OS Advanced stage

13 Results (4) Localized stage : 96 pts First results CHOP± R+RT (58pts) After CT After RT CHOP± R (38pts) P CR 40 (69%)56 (97%)20 (53%)P ˂ S PR 18 (31%)02 (03%)03 (07%)/ Overall response 58 (100%)23 (60%)P ˂ S Failure /09 (24%)/ TRM /06 (16%)/

14 Results (5) Localized stage : 90/96 pts ( 6pts have been intensified ) The out come of response: RéponseAlives in CRRelapseDeath Lost in sight pts CHOP ± R + RT (58 pts) 36 (62%)14 (24%)03 CR (05%)05 CR (09%) CHOP ± R (17/32 pts) 11 (65%)04 (24%) 02 CR (11%)

15 Results (6) Out come of the localized stage : 90 pts Alives C HOP ± R +RT : 39 (67%) CHOP ± R : 13 (41%) Death CHOP ± R +RT: 14(24%) CHOP ± R: 17 (53%) Losing sight pts CHOP ± R +RT (58pts) 1st CR 2 nd CR Relapse Failure 1st CR RelapsefailureToxicity 36 (62%) 03/ 11//05 CHOP ± R (32pts) 11 (65%) 01 /

16 EFS Localized stage 50% 45% 36%

17 OS Localized stage 66% 55%

18 Results (7) Out come of ASCT: 33pts Allogeneic SCT: 01 pt alives in CR at 9 months follow up. ASCTNumber% Status before the transplant(33pts) CR 2266 PR 1134 status after transplant(33pts) CR 2988 TRM 0412 Out come of CR (29 pts) Alives in CR 2172 Relapse 06 (5 Death- 1 alive in CR 2) 21 Death in CR 0207

19 EFS CT/ASCT

20 OS CT/ASCT

21 Conclusion The characteristics of the series : Median age 57 years(young/literature ) Advanced stages= localized stages Bulky forms represent 48%of the advanced stages Good pronostic groupe represent67%/poor pronostic groupe 33% In the localized forms: The radiotherapy increased survival regardless of previous treatment CHOP with or without R (OS at 10 years 66% vs 36%) In advanced forms: ASCT increased survival significantly(OS at 10 years 56% vs 31%) Our results do not reach the literature because of the bulky forms with the percentage is important in this population:may be should we practice a more intensive therapy(ACVBP regimen)?


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