Open AccessPS1079 CLINICAL OUTCOME OF INTENSIFIED CHEMO‐TARGETED THERAPY IN ACTIVATED B CELL NON HODGKIN LYMPHOMA
Author(s) -
Sohaib A.,
Hashim T.,
Abouelfetouh M.,
Elkhouly E.,
Alhanafy A.,
Samaka R.
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/01.hs9.0000562608.78733.02
Subject(s) - medicine , clinical endpoint , lymphoma , germinal center , diffuse large b cell lymphoma , oncology , performance status , surgery , gastroenterology , randomized controlled trial , chemotherapy , b cell , immunology , antibody
Background: Diffuse large B cell lymphoma (DLBCL) accounts for approximately a third of all NHL and is the most common lymphoma subtype in all parts of the world. Advances in DNA array has resulted in further subclassification of DLCBL into germinal center type and activated B cell type (ABC). Activated B cell type has a worse prognosis than germinal center type Aims: To assess the role of intensified chemotherapy for patients with activated B cell type of DLBCL if it would result in better outcome. Primary end point is response rate and secondary end points are PFS and toxicity, OS Methods: This is a randomized phase II study done on 82 patients. Cases are randomized into two arms. Control arm received R‐CHOP (47 patients) and test arm received R‐CHEOP (35 patients). All cases are tested for BCL‐6, MUM‐1 and CD10 to confirm being of ABC type according to Hans algorithm. GCSF was used for prophylaxis in the test arm in the form of daily 1 vial of neupogen for 3 days after the cycle. Evaluation is done by Cheson et. al. criteria. Toxicity was described according to CTCAE V4 Results: Both groups were comparable as regard age, gender, performance status, stage and LDH. Median age was 52 years for the control arm and 46 years for the test arm. Results are analyzed at a median follow up of 15 months. Complete remission at end of treatment was 70.2% for the control arm and 91.4% for the test arm (p = 0.019) while interim assessment showed 58% median tumor shrinkage for the control arm and 79% for the test arm ( p < 0.001). Median PFS was 25 months for the control arm and not reached for the test arm (p = 0.022) while median overall survival was 28 months for the control group and not reached for the test arm (p = 0.145). At one year of follow up, overall survival was 74.46% for the control arm and 91.4% for the test arm. Toxicity was comparable in both groups regarding neutropenia (p = 0.356), oral mucositis (p = 0.419), diarrhea (p = 0.54), vomiting (p = 0.504), thrombocytopenia (p = 0.308), anemia (p = 0.453), neuropathy (p = 1) Summary/Conclusion: R‐CHEOP showed more tumor shrinkage than R‐CHOP in activated B cell lymphoma with comparable toxicity. PFS was better in the first year of follow up but more time is needed to calculate mature survival data