Prognostic Value of Early Introduction of Second Line in Patients with Diffuse Large B Cell Lymphoma

Introduction: Diffuse Large B-Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL). Although potentially curable, 40% of patients with DLBCL will die of relapsed or refractory disease. Many studies proved the correlation between achievement of early response to treatment and better survival. Our study aims to assess the prognostic value of early introduction of second line chemotherapy.Methods: Randomized pilot trial of 50 adult patients with DLBCL conducted at Kasr Al-Ainy Oncology Department, ages 18-65 years, pathologically proven as DLBCL stages IIB-IV according to Ann Arbor classification, ECOG performance status 3. Patients were treated with standard dose 3- weekly R-CHOP for 3 cycles. Those achieved partial remission were randomized to either continue R-CHOP (Group A) or to shift to R-ESHAP (Group B).Results: Fifty patients were enrolled between May 2013 and September 2014. Median age was 51 years. Better outcome with non shift group (response rate=90.9% Vs 66.67%). The 12 month disease free survival in Group A was 75% while in Group B was 58% (p-value=0.049). The 12 month overall survival was 100% in Group A versus 68% in Group B (p-value=0.003).Conclusion: These results should be confirmed on larger scale studies.