Intensive polychemotherapy efficacy in young adults with diffuse B-large cells lymphoma from germinal center cells

Analysis of treatment results of 165 primary adult patients with diffuse B large-cells lymphoma (DBLCL) treating in Moscow municipal clinics is presented. Study aimed on analysis of efficacy of various dose intensity chemotherapy schedule according to disease molecular genetics variants. 28 adolescents and young adults (median age — 21.7 years) have received treatment according to pediatric BFM-NHL 90m and BFM-NHL 2004M protocols, 46 (median age — 29.0 years) and 91 (median age — 59.5) adults according to courses CHOP and R-CHOP, respectively. It was not randomized study. Germinal and postgerminal variants DBLCL were determined using immunohistochemical technique for 58 (35%) patients with appropriate primary samples. For young patients with germinal DBLCL therapy superiority of intensive BFM-NHL 90m and B-NHL 2004M protocols in relation to postgerminal variants was revealed: 5-years event-free survival (EFS) was 1.0 ± 0.0 (n = 6) versus 0.44 ± 0.15 (n = 9), respectively (p 0.05). Data receiving proves expediency of treatment adolescents and young adults with DBCLC from germinal center cells according to intensity BFM-like protocols.

1. Поддубная И.В. Неходжкинские лимфомы. В кн.: Клиническая онкогематология. Под. ред. М.А. Волковой. М.: Медицина, 2001. c. 336—75.

2. Самочатова Е.В. Неходжкинские лимфомы у детей: от патогенетической классификации к успешной терапии. Вопр гематол онкол иммунопатол педиатр 2007;6(4):5—12.

3. Hans C.P., Weisenburger D.D., Greiner T.C. et al. A gene expression-based method to diagnose clinically distinct subgroups of diffuse large B-cell lymphoma. Blood 2004;103(1):275—82.

4. Spagnolo D.V., Ellis D.W., Juneja S. et al. The role of molecular studies in lymphoma diagnosis: a review. Pathology 2004;36(1):19—44.

5. Reiter A., Schrappe M., Parwaresch R. et al. NHL of childhood and adolescence: Results of a treatment stratified for biologic subtypes and stage. A report of the BFM Group. J Clin Oncol 1995;13(2):359—72.

6. Klapper W., Szczepanowski M., Burkhardt B. et al. Molecular profiling of pediatric mature B-cell lymphoma treated in population-based prospective clinical trials. Blood 2008;112(4):1374—81.

7. Feugier P., Van Hoof A., Sebban C. et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol 2005;23(18):4117—26.

8. Семочкин С.В., Бобкова М.М., Лория С.С. и др. Опыт терапии подростков и взрослых больных с неходжкинскими лимфомами по педиатрическому протоколу NHLBFM-90m. Вопр гематол онкол иммунопатол педиатр 2007;6(1):18—25.

9. Самочатова Е.В., Мякова Н.В., Литвинов Д.В. и др. Применение Ритуксимаба (Мабтера) в комбинированном лечении В-клеточных неходжкинских лимфом у детей: предварительные результаты. Вопр гематол онкол иммунопатол педиатр 2004;3(4):54—60.

10. Shipp M.A., Harrington D.P., Anderson J.R. et al. A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med 1993;329(14):987—94.

11. Gordon L.I., Harrington D., Andersen J. et al. Comparison of a second-generation combination chemotherapeutic regimen (m-BACOD) with a standard regimen (CHOP) for advanced diffuse non-Hodgkin's lymphoma. N Engl J Med 1992;327(19):1342—9.

12. Messori A., Vaiani M., Trippoli S. et al. Survival in patients with intermediate or high grade non-Hodgkin's lymphoma: meta-analysis of randomized studies comparing third generation regimens with CHOP. Br J Cancer 2001;84(3):303—7.

13. Pfreundschuh M., Trümper L., Kloess M. et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood 2004;104(3):634—41.

14. Pfreundschuh M., Trümper L., Osterborg A. et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 2006;7(5):379—91.

15. Dave B., Weisenburger D., Higgins C. et al. Cytogenetics and fluorescence in situ hybridization studies of diffuse large B-cell lymphoma in children and young adults. Cancer Genet Cytogenet 2004;153(2):115—21.

16. Семочкин С.В. Оптимизация технологий лечения лимфопролиферативных заболеваний у подростков и лиц молодого возраста. Автореф. дис. … докт. мед. наук. М., 2007.

17. Nyman H., Adde M., Karjalainen-Lindsberg M.L. et al. Prognostic impact of immunohistochemically defined germinal center phenotype in diffuse large B-cell lymphoma patients treated with immunochemotherapy. Blood 2007;109(11):4930—5.

18. Espinosa I., Briones J., Bordes R. et al. Activation of the NF-ЇB signalling pathway in diffuse large B-cell lymphoma: clinical implications. Histopathology 2008;53(4):441—9.

19. Dunleavy K., Pittaluga S., Czuczman M. et al. Differential of efficacy of bortezomib plus chemotherapy within molecular subtypes of diffuse large B-cell lymphoma. Blood 2009;113(24):6069—76.

20. Wiernik P.H., Lossos I.S., Tuscano J.M. et al. Lenalidomide monotherapy in relapsed or refractory aggressive non-Hodgkin's lymphoma. J Clin Oncol 2008;26(30):4952—7.