The addition of rituximab to CHOP regimen(R-CHOP) has been confirmed to improve the outcome of DLBCL both for young and elderly patients. We conducted a population-based analysis to assess the efficacy and toxicity for this combined chemotherapy on adult DLBCL patients in SYSUCC, China. Meanwhile, we tried to evaluate the impact of thymosin in the patients treated by R-CHOP.
The patients with newly diagnosed DLBCL in SYSUCC from 01/2004 to 12/2011 were analyzed retrospectively. We compared the objective response, long-term survival and the rate of HBV reactivation both in R-CHOP and CHOP group respectively. The preliminary evaluation of the possible role of thymosin in the immuno-chemotherapy was included.
A total 882 consecutive patients were evaluated, 546 treated by R-CHOP and 336 treated by CHOP. Median chemotherapy cycles were 6 for R-CHOP group and 5 for CHOP group. Overall response rates of the two groups were 95.4% and 83.3% (P < 0.001); complete response rates were 76.0% and 53.6% (P < 0.001) respectively. After median follow-up of 74.1 (2.9-141.5) months, both 8-year progression-free survival (PFS) (56.2% vs. 45.6%, P < 0.001) and 8-year overall survival (OS) (68.0% vs. 58.5%, P < 0.001) were significantly improved in the R-CHOP group in comparison to CHOP group. Meanwhile, in the R-CHOP group, 102 patients received thymosin treatment for at least 3 months during and after immuno-chemotherapy. 8-year PFS and OS were higher in thymosin group (74.8% vs. 52.1%, P = 0.003; 85.2% vs. 64.2%, P < 0.001, respectively). Although HBV infection rate of the whole group was 27.3% (241/882) at baseline, only 2.2% (12/546) patients in the R-CHOP group experienced hepatitis B virus reactivation. In thymosin group, lower incidence of HBV reactivation rate was observed (0 vs. 2.7%).
The addition of rituximab to the CHOP regimen has dramatically improved the long-term outcome of newly diagnosed DLBCL patients in China. Administration of thymosin for R-CHOP therapy more than 3 months may be helpful to improve survival and to reduce the HBV reactivation. Further clinical trials are urgently needed.
Clinical trial identification
All authors have declared no conflicts of interest.