Diffuse Large Cell B-Cell Lymphoma

Staging



Ann Arbor Staging:

E Extranodal
S Spleen involvement
A/B B Symptoms

Prognosis

R-IPI (Revised International Prognostic Index) calculator.

R-IPI is determined by

Age (>60)
LDH (above normal)
ECOG PS (>3)
Ann-Arbor Stage (>3)
Extranodal sites (>1)




Extranodal DLBCL is commonly GI (40% of extranodals are GI). The stomach is the most common site. Many have H. Pylori in the tumor. This Italian study shows that CR is achieved in 60% of cases in gastric DLBCL with H. Pylori eradication alone.


Treatment

Interesting review of R-CHOP versus various alternatives.

Pfreundschuh's NHL-B2 study, comparing CHOP14, CHOP21, CHOEP14 and CHOEP21 in older (>60 years) patients.

The corresponding NHL-B1 study, comparing the same four treatments in younger, good-prognosis patients.

A study called by Hotta T, Shimakura Y, Ishizuka H, et al. called "Randomized phase III study of standard CHOP (S-CHOP) versus biweekly CHOP (bi-CHOP) in aggressive non-Hodgkin's lymphoma (NHL): Japan Clinical Oncology Group study, JCOG 9809" was apparently never published. Some of the results seem to be described here. This study was stopped prematurely at the first interim analysis, because of slight inferiority of CHOP14 compared to CHOP21. It sounds like the groups did pretty similarly, though.

Only two studies have compared R-CHOP14 to R-CHOP21. The Delarue study presented at ASH 2009 was critized for not giving G-CSF to everyone. It showed that the groups did equally well, although the follow-up is short and the final paper isn't out yet. Here is a review of the interim analysis.

Another study by Cunningham came out at ASCO 2009. Like the Delarue study, it showed the groups doing equally well.









Age




Treatment
Links