Chemotherapeutic intensity and survival differences in young patients with diffuse large B-cell lymphoma: a Swedish Lymphoma Registry study.

Young patients with diffuse large B-cell lymphoma ( DLBCL) are variably treated with rituximab combined with cyclophosphamide-doxorubicin-vincristine-prednisone (R- CHOP), CHOP-etoposide (R- CHOEP), and anthracycline-based regimens with the addition of high-dose cytarabine/methotrexate (R- HDA/M). Using the nationwide, population-based Swedish Lymphoma Registry, we evaluated outcome, by treatment and Healthcare Region, in all 751 DLBCL patients aged ≤60 years without central nervous involvement, diagnosed in Sweden between 2007 and 2012. Overall survival was estimated using multivariate Cox analysis. In patients with age-adjusted international prognostic index (aa IPI) ≥ 2, the 5-year overall survival ( OS) was 70%, 76% and 85% after R- CHOP, R- CHOEP and R- HDA/M, respectively ( P = 0·002); the corresponding estimates were 40%, 55%, and 92% in aa IPI = 3 ( P = 0·014). There were large therapeutic differences between Sweden's six Healthcare Regions for aa IPI ≥ 2: three were 'Moderate' (more R- CHOP) and three 'Intensive' (more R- CHOEP and R- HDA/M). Patients with aa IPI ≥ 2 who were treated in the Intensive Regions, showed better OS ( P < 0·00005), particularly those with aa IPI = 3 (5-year OS, 62% vs. 30%; P < 0·00005). There were no regional differences in therapy or survival in patients with aa IPI < 2. We conclude that in younger high-risk patients, survival appears superior after more intensive therapy than R- CHOP. [ABSTRACT FROM AUTHOR]