Addition of rituximab to a CEOP regimen improved the outcome in the treatment of non-germinal center immunophenotype diffuse large B cell lymphoma cells with high Bcl-2 expression

Int J Hematol. 2014 Jan;99(1):79-86. doi: 10.1007/s12185-013-1472-z. Epub 2013 Nov 21.

Abstract

Diffuse large B cell lymphoma (DLBCL) cells can be sub-classified into germinal center B cells (GCB) and non-GCB immunophenotypes. In the present study, we treated 161 newly diagnosed DLBCL patients with cyclophosphamide, epirubicin, vincristine, and prednisolone (CEOP) regimen with or without rituximab, and retrospectively investigated DLBCL sub-classifications combined with assessment of B cell lymphoma 2 (Bcl-2) expression level for their utility in the prediction of clinical efficacy. Survival analyses showed that non-GCB patients treated with R-CEOP regimen had significantly higher 5-year OS rates than the CEOP group (P = 0.033), while no statistically significant difference was observed between R-CEOP and CEOP treatments in GCB patients (P = 0.317). Prognosis was poorest for high Bcl-2 expressing non-GCB subgroup patients treated with CEOP, compared with Bcl-2 negative non-GCB CEOP patients (P = 0.044). In the R-CEOP group, Bcl-2 expression had no significant effect on prognosis for both GCB and non-GCB patients. The addition of rituximab to CEOP chemotherapy negates the adverse prognostic influence of Bcl-2 protein expression on overall survival in non-GCB DLBCL.

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / therapeutic use
  • Epirubicin / therapeutic use
  • Female
  • Gene Expression
  • Humans
  • Immunophenotyping
  • Lymphoma, Large B-Cell, Diffuse / drug therapy*
  • Lymphoma, Large B-Cell, Diffuse / metabolism*
  • Lymphoma, Large B-Cell, Diffuse / mortality
  • Lymphoma, Large B-Cell, Diffuse / pathology
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prednisone / therapeutic use
  • Prognosis
  • Proto-Oncogene Proteins c-bcl-2 / genetics
  • Proto-Oncogene Proteins c-bcl-2 / metabolism*
  • Retrospective Studies
  • Rituximab
  • Treatment Outcome
  • Vincristine / therapeutic use

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Proto-Oncogene Proteins c-bcl-2
  • Epirubicin
  • Rituximab
  • Vincristine
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CEOP protocol 1