Worse Prognosis for “Bulky” Disease Diffuse Large B-Cell Lymphoma

Posted on March 8th, 2009 by

Worse Prognosis for “Bulky” Disease Diffuse Large B-Cell Lymphoma

Young patients with diffuse large-B-cell lymphoma (DLBCL) with cancerous masses that are 10.0 centimeters or greater in diameter are considered to have “bulky” disease and have a worse prognosis than those with smaller masses. These findings were published in Lancet Oncology.

Non-Hodgkin’s lymphoma (NHL) refers to a group of cancers that originate in different cells of the immune system. Diffuse large B-cell NHL is a common type of NHL that affects immune cells called B-cells; it is considered an aggressive type of NHL.

Standard treatment for DLBCL typically includes chemotherapy with or without Rituxan® (rituxamab). Rituxan is a monoclonal antibody that has been designed to specifically bind to B-cells. When Rituxan binds to B-cells, the immune system is stimulated to attack B-cells; this action is thought to have direct cancer-killing effects.

Some patients with DLBCL have what is referred to as bulky disease, meaning that masses of cancer cells may be felt or seen on scans. The exact definition and effects on outcomes of bulky disease, however, have remained controversial. Specifically, outcomes associated with bulky disease among younger patients with DLBCL who have a good prognosis are not known.

Researchers from Switzerland recently conducted a clinical study to further evaluate the potential associations between bulky disease and outcomes among patients with DLBCL. This study included 802 patients aged between 18 and 60 years with DLBCL who had been involved in a previous trial referred to as the MInT (Mabthera International Trial Group) trial. The researchers sought to define the maximum diameter of cancerous masses, or maximum tumor diameter (MTD), that was associated with a good prognosis following the standard CHOP chemotherapy with or without Rituxan.

  • At three years patients treated with CHOP chemotherapy plus Rituxan had overall survival rates of 98% for those with an MTD less than 5 cm and 85.2% for patients with an MTD of 10 cm or greater.
  • At three years patients treated with CHOP chemotherapy without Rituxan had overall survival rates of 92.9% for those with an MTD less than 5 cm and 73.5% for those with an MTD of 10 cm or greater.

The researchers concluded: “Rituximab [Rituxan] decreased, but did not eliminate the adverse prognostic effect of MTD in young patients with good-prognosis DLBCL. Based on this study, a cut-off point of 10.0 cm might be a suitable margin in the rituximab era to delineate those patients with bulky disease.” Patients with DLBCL may wish to speak with their physician regarding their MTD and treatment options individualized according to their disease characteristics.

Reference: Pfreundschuh M, Ho A, Cavallin-Stahl E, et al. Prognostic Significance of maximum tumor (bulk) diameter in young patients with good-prognosis diffuse large-B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: an exploratory analysis of the MabThera International Trial Group (MInT) Study. Lancet Oncology. 2008; 9:435-444.

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