Lymphoma: Chemotherapy and Clinical Trials Poster II
Duration of First Remission in Diffuse Large B-Cell Lymphoma (DLBCL) Define Groups of Patients with Different Overall Survival Which Cannot Be Entirely Distinguished by Clinical Features or IPI at Diagnosis: a Prospective Population Based Study of the Scotland and Newcastle Lymphoma Group
Anne L Lennard6,*,
Jo White1,* and
Stephen J Proctor1,*
1 Haematological Sciences, Newcastle University, Newcastle, United Kingdom, 2 Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, 3 Department of Haematology, Western General Hospital, Edinburgh, United Kingdom, 4 Department of Pathology, Western General Hospital, Edinburgh, United Kingdom, 5 Veterinary Pathological Sciences, University of Glassgow, United Kingdom, 6 Department of Haematology, Royal Victoria Infirmary, Newcastle, United Kingdom, 7 Department of Radiotherapy, Northern Centre for Cancer Treatment, Newcastle, United Kingdom, 8 Department of Haematology, Western Infirmary, Glasgow, United Kingdom, 9 Department of Haematology, Ninewells Hospital, Dundee, United Kingdom
The aim of this study was to evaluate the influence of durationof first remission (FR) on overall survival (OS) of patients(pts) with DLBCL in a population-based setting, and furtherto assess the possible differences in clinical features or IPIbetween pts with different duration of FR. We analyzed all DLBCLpts registered on the database of the Scotland and NewcastleLymphoma Group. Further inclusion criteria were age >18 yrsand defined clinical stage (CS) at presentation, treatment withanthracycline based chemotherapy, and no immunotherapy or stemcell transplantation in first line treatment. According to durationof FR four groups were defined; "refractory"-pts who did notrespond to first line treatment or relapsed within 9 monthsfrom diagnosis, "early relapse"-pts who relapsed within 9–18months from diagnosis, "late relapse"-pts who relapsed after18 months from diagnosis and "no relapse"-pts who did not relapse.From 1990 to 2003, 2025 DLBCL pts were registered within thedatabase and 1391 pts fulfill inclusion criteria. The medianage at diagnosis was 64 yrs, 40% of pts were aged 60yrs, 51%of pts were male, 79% of pts had ECOG <1. 18% of pts werediagnosed with CS I, 28% with CS II, 25% with CS III and 29%with CS IV. B-symptoms were present in 42% of pts, extranodalinvolvement in 34%, and marrow involvement in 16% and bulkydisease in 53%. IPI was calculated for 803 pts–38% ofthem had low IPI, 26% low intermediate IPI, 22% high intermediateIPI and 14% high IPI. 5yr progression free survival and OS wererespectively 37% and 46%. 566 pts (41%) were in "refractory–group",92 (7%) pts in "early relapse–group", 120 (9%) pts in"late relapse–group" and 597 pts (43%) in "no relapse–group",16 pts was excluded due to short follow-up time. Among pts 60yrs,the proportion were 33%, 7%, 8% and 52% respectively and amongpts >60 yrs 46%, 7%, 9% and 38%, respectively. 5 yrs OS was8% in "refractory–group", 16% in "early relapse–group",50% in "late relapse–group" and 90% in "no relapse–group",differences between the groups were statistically significant,p<0.001. These results were confirmed for pts 60 yrs–5yrs OS was 13%, 31%, 66% and 94% respectively, p<0.001 andfor pts >60yrs 4%, 6%, 40% and 85%, respectively, p<0.001.Importantly, 45% of pts in "refractory group" had low and low-intermediateIPI, 57% in "early relapse group", 79% in "late relapse group"and 80% in "no relapse group" in evaluation of all pts, p<0.001.In evaluation of pts 60yrs, the proportions for age-adjustedIPI were 31%, 53%, 77% and 77%, respectively, p<0.001 andof pts >60yrs 32%, 50%, 76% and 68%, respectively, p<0.001.There were statistical significant differences in IPI and age-adjustedIPI between "refractory" and "no relapse" groups tested forall pts, pts 60yrs and pts >60yrs, however there were nostatistically significant differences between "early relapsed"and "late relapse" groups. To assess the further potential differencesin clinical features at presentation between "primary refractory"vs "no relapse" pts and "early relapse" vs "late relapse" pts,the groups were compared for the following factors: age, sex,CS, B-symptoms, ECOG, extranodal and bone marrow involvement,bulky disease, haemoglobin, leukocytes, LDH, albumin, urea,and alkaline phosphatase serum level. In evaluation of all ptsand pts 60 years the "primary refractory–group" differedstatistically significantly from the "no relapse group" in allevaluated factors except of sex and in evaluation of pts >60yrsin all factors. The "early relapse group" differed statisticallysignificantly from the "late relapse group" only in ECOG performancestatus in evaluation of all pts, CS and bulky disease in evaluationof pts 60 years and age and CS in evaluation of pts >60yrs.In a population-based study of pts with DLBCL treated with anthracyclines,duration of FR defined groups of pts with statistically differentOS. It was impossible to distinguish entirely by clinical featuresor IPI at diagnosis. We conclude, that the currently used prognosticindices based on clinical factors need to be enhanced usingbiological features of the tumor.
Disclosures: No relevant conflicts of interest to declare.