Outcome of Advanced Stage Diffuse Large B-Cell Lymphoma; Experience from Saudi Arabia

Abstract

Background Diffuse large B-cell lymphoma (DLBCL) is one of the most common subtypes of non-hodgkin lymphoma, and an aggressive cancer of B-cells. As per the Saudi Cancer Registry, the reported DLBCL prevalence in Saudi Arabia is 15(22.7%) in males and 3(13%) in females (1). CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) is the standard of care (2), however, the outcome had displayed significant improvement with rituximab addition. The treatment adjustment is required as per the International Prognostic Index (IPI), based on a patient's profile (age and the associated risk factors)(3,4). There is high mortality in relapsed and refractory cases. The overall survival 0.40 (95% CI, 0.27-0.61), and the progression free survival 0.40 (95% CI, 0.27-0.61) had improved with the addition of rituximab. Methods A retrospective cohort study was employed in year 2016 for patients diagnosed with DLBCL during 2008-2018. The patients were followed up for five years from the treatment till the outcome death or survival. The collected data included demographics, clinical characteristics, ECOG status, Ann Arbor stage, bulky disease, spleen/ extra-nodal involvement, disease status, received line of therapies, and the outcome. Study was approved by the institutional ethical committee (RC14/076). Results A total of 145 consecutive patients were enrolled. The median age was 67 (20-111) years. Little more than half of the sample 80(55%) were males. The B-symptoms were positive in 42(46%). Almost two-thirds 103(71%) had ANN Arbor stage III or IV. 19(22%) had three or more co-morbidities. 58(50.43%) patients had a high-intermediate/ high IPI risk category. Chemotherapy/ Immunotherapy was most common mode of therapy 140(96%), followed by radiotherapy 20(14%). 9(6%) had received stem cell transplantation. First line of therapy was received by 134(92%), followed by second line of therapy19(13%), third line of therapy and above in 9(6.2%). 95(71%) patients had received R-CHOP as a first line of therapy, followed by R-CVP 15(11%), ABVD 3(2.24%), R-bendamustine 2(1.5%), Rituximab 2(1.5%), and others 17(12.68%). The mid treatment evaluation using PET was negative in 16(28%), and post therapy PET evaluation was negative in 44(51%). The five years overall survival was 78%, and five years progression free survival was 74% (figure 1). Conclusion Despite the advanced and high-risk presentation in the majority of patients diagnosed with DLBCL, the 5-year overall survival and progression free survival appears similar or better than what has been reported in literature. This can be attributed to the individualization of therapy based on clinical stage and risk factors. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal