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• W3094012719 abstract "The optimal treatment for stage I-II diffuse large B-cell lymphoma (DLBCL) is controversial. We sought to measure outcomes for patients with stage I-II DLBCL who received rituximab-chemotherapy with or without radiotherapy (RT) investigating prognostic factors including cytogenetics and early response to treatment by PET-CT. We performed a retrospective study of all consecutive patients with Ann Arbor stage I-II DLBCL treated with rituximab-based chemotherapy with or without RT from 2001-2017 at our institution. We measured progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method. Pathology, cytogenetic studies, and PET-CT were centrally reviewed. Response after 2 cycles of systemic therapy by PET-CT (iPET2) was scored using the 5-point Deauville scale (DS) and the ΔSUVmax method. Two-sided P-values<0.05 were considered significant with analyses performed using R (Vienna, Austria). We identified 180 patients with median follow up of 7.7 years (interquartile range [IQR] = 5-12.7). The majority were male (60.6%), had stage II (54.4%), were without B-symptoms (86.7%), had extranodal involvement (53.9%), had stage-modified IPI 0-1 (mIPI, 53.8%), and had non-bulky disease (<7 cm, 72.8%). Seven cases were reclassified as high-grade B-cell lymphoma with translocations of MYC and BCL2 and/or BCL6 (double/triple hit). 113 patients (62.8%) received rituximab-chemotherapy (median 5 cycles, IQR = 4-6 with R-CHOP for n = 92 [81.4%]) followed by RT (median dose = 36 Gy, IQR = 30.6-36). 54 patients (30.0%) received rituximab-chemotherapy alone (median 6 cycles, IQR = 6-6, with R-CHOP for n = 42 [77.8%]). 13 patients (7.2%) had primary refractory disease and underwent intensive salvage treatments. 8-year PFS and OS for the entire group of 180 patients were 69.8% and 78.2%, respectively. Notably, 5 of 24 relapses (20.8%) occurred after 5 years of follow up. There was a significantly higher 8-year PFS, 79.9% vs. 58.2% (P<0.0001), and OS, 87.5 vs. 67.9% (P<0.0001), for mIPI 0-1 vs. mIPI >1, respectively. Only increasing age and increasing size (per cm) were associated with worse PFS and OS on univariable and multivariable analyses (P<0.05). For 77 (42.8%) with cytogenetic testing available, PFS (P = 0.58) and OS (P = 0.24) were no worse for double/triple hit versus non-translocated. For 56 (31.1%) with iPET2 available, a DS>3 was associated with worse PFS (P<0.0001, ROC curve AUC = 80.3%) and had greater prognostic utility compared to ΔSUVmax (ROC curve AUC = 76.1%). Finally, there was a significantly lower rate of local recurrence for patients who received RT as part of primary treatment (P = 0.03). PFS and OS for patients with stage I-II DLBCL were excellent following rituximab-chemotherapy with or without RT for those who were low risk (mIPI 0-1). Late relapses were not uncommon in our cohort, emphasizing the importance of long-term follow up for stage I-II DLBCL." @default.
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• W3094012719 date "2020-11-01" @default.
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• W3094012719 title "Long-Term Outcomes For Stage I-II Diffuse Large B-Cell Lymphoma Treated With Rituximab And Chemotherapy With Or Without Radiotherapy" @default.
• W3094012719 doi "https://doi.org/10.1016/j.ijrobp.2020.07.186" @default.
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