Is there a benefit to adding rituximab to CHOP in the overall survival of patients with B-cell non-Hodgkin’s lymphoma in a developing country?

Author： Ruiz-Delgado Guillermo J Gómez-Almaguer David Tarín-Arzaga Luz C Cantú-Rodriguez Olga G Urdaneta Carlos Alarcón Rodríguez-Morales Uxmal Calderón-Garcia Jackeline Fernández-Vargas Omar Montes-Montiel Maryel Sánchez-Cárdenas Mónica Ruiz-Argüelles Guillermo J

Publisher： Maney Publishing

ISSN： 1024-5332

Source： Hematology, Vol.17, Iss.4, 2012-07, pp. : 193-197

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Abstract

Rituximab (R) has changed the prognosis of patients with non-Hodgkin’s lymphoma (NHL) in developed countries, but its role has not been analyzed in underprivileged circumstances. One hundred and two patients with NHL treated in a developing country were analyzed: 28 patients with follicular lymphoma (FL) and 74 with diffuse large B-cell lymphoma (DLCL). Patients were treated upfront with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or R-CHOP; the decision to employ R depending solely on the ability of patients to defray it. In DLCL, 42 were given CHOP and 32 R-CHOP, whereas in FL, 19 were given CHOP and 9 R-CHOP. The impact of the addition of R was found to be clearer in FL than in DLCL. In patients with DLCL, the overall survival (OS) was 87% at 80 months for those treated with R-CHOP and 84% at 145 months for those treated with CHOP (not significant). In patients with FL, the OS was 89% at 88 months for those treated with R-CHOP and 71% at 92 months for those treated with CHOP (P = 0.05). In a multivariate analysis, other variables which were identified to be associated with the OS were IPI and number of cycles in DLCL. It is concluded that R produced a mild positive impact in the OS of patients with FL, but not in those with DLCL. Since the addition of R results in a 36-fold increase in treatment costs, these observations may be important to decide therapeutic approaches in NHL patients living in underprivileged circumstances.