Rituximab-CHOP and Rituximab-ESHAP/MINE in B Follicular and Diffuse NHL as Front Line Therapy in Newly Diagnosed and Relapsed Patients.

Background: NHL is a heterogeneous lymphoid group, in respect of clinical, histological and biological point of view. Follicular Lymphoma (FL) and Diffuse Large B Cell (DLBCL) account together for two/thirds of pts. Inmunophenotypic studies allow separation in B and T, important criteria to decide therapy. Objectives basically were:

1. To asses age, sex incidence, clinical staging, IPI, inmunohistochemical determinations to identify B NHL

2. Evaluation of Chemotherapy and immunotherapy combined in Rituximab (R)-CHOP and R-ESHAP/MINE (R-E/M) as Induction Protocol in front line for newly diagnosed pts and salvage therapy for relapsed pts, determining Overall Survival (OS) and Disease Free Survival (DFS), applying p value to estimate significance.

Patients and Methods: Twenty five pts, 10 males and 15 females, with 56.6±15.19 y/o [range (r) 33–83] were studied at Hematology Center of Central Hospital in the west of Venezuela (Maracaibo), from the standpoint of histology, inmunohistochemistry, staging (laboratory, imaging procedures) and optional investigations like chromosomal, molecular, monoclonal markers including CD20, CD45RO (all pts) and BCL-2 in 15 cases.

Results: In 52% of pts were <60 and in 48% >60 y/o; I-IIA/B 9 pts, III-IVA/B 16 pts, IPI in the whole group was 1–2 in 18 pts, 3–4 in 7 pts. By histology 13 pts, were DLBCL and 12 FL. All cases were CD20+; 22 pts received R-CHOP and 3 previously treated pts were given R-E/M), achieving CR in 23 of the whole series (92%) and PR 2 (8%); 3/22 pts treated with R-CHOP relapsed and were placed on R-E/M, so there were 6 pts on this salvage schedule and CR was obtained in 5 with 1 PR. OS of R-CHOP × 6 cycles and R-CHOP × 8 cycles was not significant (ns). DFS in all pts was 26.3±15.9 (r 1–67 m) with ns difference between arms of 6 and 8 cycles. In 13 DLBCL pts OS was statistical ns; DFS in DLBCL and FL was ns. Pts <60 compared with >60 y/o OS was ns; 11 pts were placed on maintenance with R each/2 m/2 years, 10 of them have actually been reached 10–12 doses accomplished and 1 pt 6 doses; 14 pts have not received maintenance. Four pts died, 3 due to cardiac complications and 1 due to toxicity, pancytopenia and sepsis.

Conclusion: The efficacy of R-CHOP is relevant in B-NHL and it is similar to the experience so far obtained at the majority institutions working with this kind of clinical trails. Despite E/M protocols have demonstrated efficacy in past experiences, when additional R is used, appears feasible to increase CR, and possibilities of cure as 5/6 pts achieved prolonged continuous CR (r 32–48 m) except for one patient with several relapses. DLBCL is aggressive disease and FL is indolent, but there are not significant differences from de statistical point of view in relation of OS and DFS, probably due to Rituximab incorporation to the classical and salvage chemotherapy.