Chemotherapeutic intensity and survival differences in young patients with diffuse large B‐cell lymphoma: a Swedish Lymphoma Registry study

Summary Young patients with diffuse large B‐cell lymphoma ( DLBCL ) are variably treated with rituximab combined with cyclophosphamide‐doxorubicin‐vincristine‐prednisone (R‐ CHOP ), CHOP ‐etoposide (R‐ CHOEP ), and anthracycline‐based regimens with the addition of high‐dose cytarabine/methotrexate (R‐ HDA /M). Using the nationwide, population‐based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age‐adjusted international prognostic index (aa IPI ) ≥ 2, the 5‐year overall survival ( OS ) was 70%, 76% and 85% after R‐ CHOP , R‐ CHOEP and R‐ HDA /M, respectively ( P  = 0·002); the corresponding estimates were 40%, 55%, and 92% in aa IPI  = 3 ( P  = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aa IPI  ≥ 2: three were “Moderate” (more R‐ CHOP ) and three “Intensive” (more R‐ CHOEP and R‐ HDA /M). Patients with aa IPI  ≥ 2 who were treated in the Intensive Regions, showed better OS ( P  < 0·00005), particularly those with aa IPI  = 3 (5‐year OS , 62% vs. 30%; P  < 0·00005). There were no regional differences in therapy or survival in patients with aa IPI  < 2. We conclude that in younger high‐risk patients, survival appears superior after more intensive therapy than R‐ CHOP .