Chan myae htut

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Chan myae htut

  1. 1. Moscow State University Faculty of Basic Medicine Presented by Dr.Chan Myae Htut (M.B.B.S) Supervisors – Prof Dr. B.I.Polyakov,Dr.D.A.Bykov May 19,2010 CHOP CHEMOTHERAPY PLUS RITUXIMAB COMPARED WITH CHOP ALONE IN ELDERY PATIENTS WITH DIFFUSE LARGE B CELL LYMPHOMA
  2. 2. INTRODUCTION <ul><li>Lymphoma – cancer of the lymphatic system. </li></ul><ul><li>Two types </li></ul><ul><li>- Hodgkin’s lymphoma (HL) </li></ul><ul><li>- Non Hodgkin’s lymphoma (NHL) </li></ul><ul><li>DLBCL NHL </li></ul><ul><li>DLBC L heterogenous group of aggressive lymphoma of large transformed B cells. </li></ul><ul><li>30% of all NHL </li></ul><ul><li>Middle-aged and older person </li></ul><ul><li>Median age at diagnosis – 64 yrs </li></ul><ul><li>Men > Women </li></ul>
  3. 3. ETIOLOGY AND PATHOGENESIS <ul><li>No apparent etiology </li></ul><ul><li>Risk factors </li></ul><ul><li>- personal & family history of NHL </li></ul><ul><li>- primary immunosuppression </li></ul><ul><li>- autoimmune disorders </li></ul><ul><li>- organ transplantation </li></ul><ul><li>- occupational exposures to toxins </li></ul>
  4. 4. CLINICAL FEATURES <ul><li>Typical presentation rapidly enlarging lymph node or an abdominal mass </li></ul><ul><li>B symptoms - 30% </li></ul><ul><li>- drenching night sweats </li></ul><ul><li>- fever </li></ul><ul><li>-weight loss </li></ul><ul><li>Extra nodal presentation GIT, bone, thyroid, skin, breast, live, nasal cavity, salivary glands, CNS </li></ul>
  5. 5. DIAGNOSIS <ul><li>Lymph node biopsy </li></ul><ul><li>Imaging studies </li></ul><ul><li>Bone marrow tests </li></ul><ul><li>Lumber puncture </li></ul>
  6. 6. Therapy(In patients older than 60 years) <ul><li>Standard CHOP </li></ul><ul><li>C - cyclophosphamide ( 750 mg/m 2 on day 1 ) </li></ul><ul><li>H - doxorubicin ( 50 mg/m 2 on day 1 ) </li></ul><ul><li>O - vincristine ( 1.4-2 mg/m 2 on day 1 ) </li></ul><ul><li>P - prednisone ( 40 mg/m 2 for 5 days ) </li></ul><ul><li>every 3 weeks for 8 cycles </li></ul><ul><li>Another R-CHOP </li></ul><ul><li>R -rituximab anti CD-20 monoclonal antibody </li></ul><ul><li>( 375 mg/m 2 on day 1 ) </li></ul>
  7. 7. AIM OF STUDY <ul><li>To identify the advantages of usage of monoclonal antibody (Rituximab) with standard chemotherapeutic agents in patients with diffuse large B cell lymphoma </li></ul>
  8. 8. OBJECTIVE OF STUDY <ul><li>To identify the prognostic significance of diffuse large B cell lymphoma patients by the treatment of R-CHOP and CHOP alone </li></ul><ul><li>To determine the significance of drug toxicities of R-CHOP and CHOP </li></ul>
  9. 9. DESIGN OF STUDY 52 PATIENTS 27 PATIENTS R-CHOP 25 PATIENTS CHOP 27 PATIENTS R-CHOP
  10. 11. MAIN CHARACTERISTICS OF PATIENTS (N=52) CHARACTERISTICS R-CHOP (N=27) NO(%) CHOP (N=25) NO(%) Age <65 yrs 65 – 69 yrs 70 -74 yrs > 74 yrs 6 (22) 8 (28) 7 (26) 6 (22) 6 (24) 8 (31) 7 (28) 4 (16) Male Sex 12 (46) 16 (54) Performance Status 0 1 > 1 9 (33) 12 (45) 6 (22) 9 (36) 12 (48) 4 (17) B symptoms 11 (39) 9 (36) Stage I II III IV 0 5 (20) 4 (16) 18 (63) 0 5 (20) 4 (15) 16 (65)
  11. 12. MAIN CHARACTERISTICS OF PATIENTS (N=52) (Contd.) CHARACTERISTICS R-CHOP (N=27) NO(%) CHOP (N=25) NO (%) No of extra nodal sites 0 1 >2 6 (23) 13 (47) 8 (30) 6 (22) 12 (52) 7 (26) Bulky tumour (>10cm) 8 (30) 8 (32) Bone marrow involvement 8 (30) 7 (28) Standard International Prognostic Index Score 0-1 2 3 4-5 4 (16) 9 (32) 11 (39) 3 (15) 3 (12) 9 (35) 10 (42) 3 (12)
  12. 13. RESPONSE TO TREATMENT RESPONSE R-CHOP (N=27) NO(%) CHOP (N=25) NO(%) Complete response Unconfirmed complete response Partial response Progressive disease Death without progression 14 (52) 6 (23) 2 (7) 3 (9) 2 (6) 9 (37) 7 (26) 2 (6) 5 (22) 2 (1)
  13. 14. EVENT FREE SURVIVAL
  14. 15. OVERALL SURVIVAL
  15. 16. NONHEMATOLOGIC ADVERSE EVENTS
  16. 17. NONHEMATOLOGIC ADVERSE EVENTS(Contd.)
  17. 18. DISCUSSION <ul><li>Higher response rates and improved event-free and overall survival among patients treated with the combination of rituximab and CHOP </li></ul><ul><li>Longer survival in the CHOP-plus-rituximab group was due to lower rate of disease progression during therapy and fewer relapses among patients who had a complete response </li></ul><ul><li>Treatment with CHOP plus rituximab was well tolerated, and the incidence of severe or serious adverse events was no different from that in the CHOP group </li></ul>
  18. 19. CONCLUSION <ul><li>The addition of rituximab to CHOP chemotherapy , given for eight cycles to eldery patients with newly diagnosed diffuse large B cell lymphoma, significantly increase the rate of complete response, decrease the rates of treatment failure and relapse, and improves event-free and overall survival as compared with standard CHOP alone . </li></ul><ul><li>These gains were achieved without a significant increase in clinically significant toxic effects. </li></ul>

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