Originally published as JCO Early Release 10.1200/JCO.2005.09.137 on June 13 2005

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Introduction of Combined CHOP Plus Rituximab Therapy Dramatically Improved Outcome of Diffuse Large B-Cell Lymphoma in British Columbia

From the Divisions of Medical Oncology and Pathology, and the Program for Disease Control of the British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada

Address reprint requests to Laurie H. Sehn, MD, MPH, BC Cancer Agency, Vancouver Clinic, 600 W 10th Ave, Vancouver, BC, Canada V5Z 4E6; e-mail: lsehn@bccancer.bc.ca

PURPOSE: For more than two decades, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has been the standard therapy for diffuse large B-cell lymphoma (DLBCL). The addition of rituximab to CHOP has been shown to improve outcome in elderly patients with DLBCL. We conducted a population-based analysis to assess the impact of this combination therapy on adult patients with DLBCL in the province of British Columbia (BC).

METHODS: We compared outcomes during a 3-year period; 18 months before (prerituximab) and 18 months after (postrituximab) institution of a policy recommending the combination of CHOP and rituximab for all patients with newly diagnosed advanced-stage (stage III or IV or stage I or II with "B" symptoms or bulky [> 10 cm] disease) DLBCL.

RESULTS: A total of 292 patients were evaluated; 140 in the prerituximab group (median follow-up, 42 months) and 152 in the postrituximab group (median follow-up, 24 months). Both progression-free survival (risk ratio, 0.56; 95% CI, 0.39 to 0.81; P = .002) and overall survival (risk ratio, 0.40; 95% CI, 0.27 to 0.61, P < .0001) were significantly improved in the postrituximab group. After controlling for age and International Prognostic Index score, era of treatment remained a strong independent predictor of progression-free survival (risk ratio, 0.59; 95% CI, 0.41 to 0.85; P = .005) and overall survival (risk ratio, 0.43; 95% CI, 0.29 to 0.66; P < .001). The benefit of treatment in the postrituximab era was present regardless of age.

CONCLUSION: The addition of rituximab to CHOP chemotherapy has resulted in a dramatic improvement in outcome for DLBCL patients of all ages in the province of BC.

Supported by the Turner Family Lymphoma Outcome Unit Fund, the Yvette Porte Lymphoma Research Endowment, and an unrestricted grant from Roche Canada Inc.

Presented at the annual meeting of the American Society of Hematology (preliminary results), San Diego, CA, December 2003.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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