First-Line CEOP with or without Rituximab for Treating Diffuse Large B Cell Lymphomas: Predictive Value of the Absolute Lymphocyte Count
2012
Background and purpose: The R-CHOP regimen containing rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone is standard frontline chemotherapy for treating diffuse large B cell lymphomas (DLBCLs). Epirubicin instead of doxorubicin is administered in the R-CEOP regimen, especially for patients with concerns about cardiotoxicity. Meanwhile, the absolute lymphocyte count (ALC) shows prognostic significance in some subtypes of lymphoma. However, the role of the ALC in DLBCL patients receiving R-CEOP or CEOP is not yet clear. Hence, we attempted to elucidate the prognostic value of the ALC. Methods: Patients' characteristics and treatment outcomes in a single institution between January 2001 and December 2009 were retrospectively analyzed. Results: In total, 174 patients with a DLBCL were enrolled. Seventy-three patients received CEOP, and 101 patients received the R-CEOP regimen. In patients receiving R-CEOP, the progression-free survival (PFS) rate was significantly higher than in those without rituximab (p = 0.0035). In addition, rituximab proved to be an independent prognosticator in the multivariate analysis of PFS (hazard ratio = 0.333; 95% confidence interval (CI), 0.187~0.591; p < 0.001). The ALC was independently predictive of complete remission in the multivariate analysis (relative risk = 3.115; 95% CI, 1.304~7.441; p = 0.011). In contrast to the CEOP counterpart, a poor prognostic value of a low ALC in PFS was demonstrated in the R-CEOP subgroup (hazard ratio = 3.095; 95% CI, 1.335~7.180; p = 0.008). Conclusions: In DLBCL, rituximab significantly increased PFS, and the ALC at diagnosis was remarkably prognostic for PFS. Because of the limitations of this retrospective study, the efficacy of rituximab and the role of ALC in the overall survival might have been underestimated. Long-term follow-up is warranted to validate these results.
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