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Impact of Inadequate Doses of Rituximab in the Treatment of Diffuse Large B Cell Lymphoma in Malaysian Patients

  • Gan, Gin Gin (Department of Medicine, Faculty of Medicine, University Malaya) ;
  • Subramaniam, Rajaletchumy (Department of Medicine, Faculty of Medicine, University Malaya) ;
  • Bee, Ping Chong (Department of Medicine, Faculty of Medicine, University Malaya) ;
  • Chin, Edmund Fui Min (Department of Medicine, Faculty of Medicine, University Malaya) ;
  • Abdul-Halim, Habibah (Department of Medicine, Faculty of Medicine, University Malaya) ;
  • Tai, Mei Chee (Department of Medicine, Faculty of Medicine, University Malaya)
  • Published : 2014.02.28

Abstract

Background: The current standard treatment for patients with newly diagnosed diffuse large B cell lymphoma (DLBCL) is rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP). A significant number of patients were not treated with recommended dose of rituximab due to limited financial resources in Malaysia. This study evaluates the efficacy of R-CHOP like chemotherapy in Malaysian patients with DLBCL. Materials and Methods: The study comprised a retrospective analysis of patients with DLBCL treated at a single centre. The outcome was compared with patients who were treated with R-CHOP like and CHOP like chemotherapy. Patients who were treated with lower dose of rituximab was subanalysed for outcome. Results: A total of 86 patients who had CHOP-like chemotherapy were included. Only 39 (45%) patients had rituximab and only 12 (29%) patients had the recommended dose. The overall response (OR) and complete response (CR) rates were 88% and 81% respectively. There was no significant difference in OR and CR in patients who had rituximab and those without rituxmab. Those with International Prognostic Index (IPI) score of ${\leq}2$ had significant higher CR rate, progression free survival (PFS) and overall survival (p<0.001). Conclusions: The lack of significant improvement in CR and DFS in our patients may be due to an inadequate dose of rituximab.

Keywords

Diffuse large B cell lymphoma;rituximab;CHOP

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