Comparación entre CHOP-like y R-CHOP en pacientes con linfoma no Hodgkin difuso de grandes células B y folicular: 10 años de experiencia del Hospital de Clínicas de Montevideo, Uruguay / Comparison between CHOP-like and R-CHOP in diffuse large B cell and follicular lymphoma

Background: The most common types of non-Hodgkin lymphoma (NHL) are diffuse large B cell (DLBCL) and follicular (FL). Aim: To analyze the benefit ofRituxi-mab in overall survival (OS) of patients with NHL. Material and Methods: Review of medical record of 230 adult patients with afirst episode of NHL admitted between 2002 and 2011. We included 67 patients with DLBCL and 36 patients with FL. Results: The overall response (OR) was 64% with 39% complete remissions (CR) in DLBCL treated with CHOP-like and 100% with 89% CR with R-CHOP. The median OS with CHOP-like was 21 months versus not attained R-CHOP (p = 0.016). There was a statistically significant difference in median event-free survival (EvFS) in favor of R-CHOP: not attained versus 8.3 months for CHOP-like (log rank (p = 0.002)). In FL, the OR in patients treated with R-CHOP or R-CHOP-like was 85%) with 54% CR. With CHOP-like the OR was 59%> with 18% CR. The OS at 24 and 36 months in patients treated with R-CHOP or R-CHOP-like was 83 and 65%. The figures for patients treated with CHOP-like were 80 and 66%> respectively. The progression free survival (PFS) was 21 months with CHOP-like versus not attained with R-QT (p = 0,043). Conclusions: When Rituximab was added to CHOP, there was a higher CR, EvFS and OS in DLBCL and higher CR and PFS in FL.

Hematopoietic stem cell transplantation for patients with advanced-stage follicular lymphoma.

Patients with advanced-stage follicular lymphoma (FL) are considered to be incurable and eventually relapse after conventional chemotherapy. High-dose therapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) can unequivocally prolong the disease-free survival (DFS) but not overall survival (OS) in the first complete remission and in a salvage setting. Recently, the incorporation of rituximab and radioimmunoconjugates in HDT with AHSCT seems to be promising and widely accepted. Although allogeneic hematopoietic stem cell transplantation (alloHSCT) consistently demonstrates longer DFS compared with historical controls of HDT followed by AHSCT, this approach cannot be considered as a standard of care due to its unacceptably high treatment-related mortality (TRM) and the lack of improving OS. With highly encouraging results and less TRM, the role of nonmyeloablative hematopoietic stem cell transplantation (NMHSCT), especially after AHSCT needs to be validated in randomized controlled trials with a long-term follow-up.