TORNA ALL’ELENCO

Frequency and clinical outcome of primary refractory disease in nonhodgkin's lymphoma: A retrospective survey on 3,492 newly diagnosed patients undergoing first-line chemotherapy in Haematologica

2013
AO Ordine Mauriziano

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (11)Vedi tutti...

Tarella C

Gueli A

Delaini F


et alii...

Abstract

Introduction. Non-Hodgkin's lymphoma (NHL) is a malignancy usually sensitive to chemotherapy. However, a variable group of patients shows refractory disease, i.e. poor or absent response to induction therapy. The present study was undertaken to define on a large series of NHL: i. the overall rate of refractory patients; ii. the main clinical factors associated with refractory disease; iii. the long-term outcome of refractory vs responsive NHL. Patients and Methods. Data have been collected on 3,492 patients, referred at the University Hematology of Torino (S. Giovanni B. and Mauriziano Hospitals) (865 cases) and the Hematology Division of Bergamo (2,627 cases), between 1984 and 2012. There were 46% female patients, 53% were aged < 60 yrs, B-cell NHL were 92%; main histological subtypes were Diffuse Large Cell (50.5%) and Follicular (18.8%) Lymphoma. There were 64.5% patients with advanced-stage disease, 31% had an intermediate-high IPI score. Overall, 42% received conventional therapy supplemented with rituximab. The criteria to identify primary refractory NHL were: stable or progressive disease (fully refractory) or transient response with disease progression within 6 months (early relapse). Results. Among 3.175 patients analysed for their primary response, 699 (22%) were refractory (12% fully refractory, 10% early relapse). The overall incidence of refractory NHL was similar in Torino and Bergamo Centers. The rate of refractoriness was 41.8% in the small T-cell subgroup. Besides T-cell histology, the following factors had the highest association with treatment response: i. intermediate-high IPI score (32.3% refractory patients); ii. female gender, with a markedly lower incidence (19.1%); iii. rituximab addition, that cut the incidence of refractoriness to 13.6% vs 28.6% for patients treated without rituximab. At present, 2,029 (58.1%) patients are alive, the overall survival (OS) was significantly poorer for fully refractory (median survival: 0.8 yrs) compa

Keywords

rituximab; patient; chemotherapy; human; hematology; society; nonhodgkin lymphoma; relapse; therapy; T lymphocyte; lymphoma; survival; female; B lymphocyte; disease course; hospital; risk; overall survival; gender; treatment response; histology; university;