2014, Number 5
<< Back Next >>
Rev Invest Clin 2014; 66 (5)
Impact of a federal program on response rate & survival, in a cohort of patients with diffuse large B-cell lymphoma. Analysis in a single national reference institution in México
Candelaria M, Labardini-Mendez J, Ramírez-Ibarguen AF, Avilés-Salas A,Estrada-Lobato E, Meneses-García A, Mohar A
Language: English
References: 27
Page: 399-406
PDF size: 164.50 Kb.
ABSTRACT
The actual standard of care of diffuse large B-cell lymphoma
(DLBCL) includes rituximab in combination with chemotherapy,
with response rates up to 76%. However, this treatment
may not be accessible to many patients, particularly in developing
countries, where most of the treatment must be paid
from the pocket of patients or their families. In México, since
2011 a federal program has fully covered this treatment of patients
with DLBCL. At the Instituto Nacional de Cancerología
(INCan) in Mexico City, 214 new cases with this disease were
treated without cost with the standard of care in 20 months.
The mean age at diagnosis was 56.7 ± 15.9 (22-91). This series
of cases was compared with a retrospective analysis of
cases with DLBCL attended at the INCan between 2006-2009.
A total of 264 cases were retrospectively analyzed. No differences
were found in demographic and clinical characteristics
at time of diagnosis. However a clear positive impact was
found in the group that received full treatment thanks to
this new social coverage by this new social security program.
The follow-up and completion of treatment was 99 %. In contrast;
from 264 in the retrospective group (79%) were treated,
but only 29 (10.9%) were able to receive an optimal treatment,
including rituximab. These differences in treatments had a
clearly impact on the response rate: 66.8
vs. 50.7% global response
(full treatment
vs. retrospective group, respectively).
These results demonstrate the importance of social programs
that may accessible standard treatment options in countries
with limited resources.
REFERENCES
1 . Globocan 2008. Disponible en: http://globocan.iarc.fr/ (September 12, 2013).
Delarue R, Tilly H, Mounier N, et al. Dose-dense rituximab- CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. The Lancet 2013; 14: 525-33.
Pfreundschuh M, Trümper L, Österborg A, et al. CHOP-like chemotherapy plus Rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-Bcell lymphoma: a randomized controlled trial by the MabThera ® International Trial (MInT) Group. Lancet Oncol 2006; 7: 379-91.
Pfreundschuh M, Kuhnt E, Trümper L, et al. CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diff use large-B-cell lymphoma: 6-year results of an open-label randomized study of the MabThera International Trial (MInT) Group. Lancet Oncol 2011; 12: 1013-22.
Winter MC, Hancock BW. Ten years of Rituximab in NHL. Expert Opinion Drug Safety 2009; 8: 223-35.
Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B cell lymphoma. N Engl J Med 2002; 346: 235-42.
Shipp MA, Harrington DP, Anderson JR, et al. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med 1993; 329: 987-94.
Sehn LH, Berry B, Chhanabhai M, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 2007; 109: 1857-61.
Hans CP, Weisenburger DD, Greiner TC, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 2004; 103(1): 275-82.
Cheson BD, Pfistner B, Juweid ME, et al. IWG Revised Response Criteria for Malignant Lymphoma: Special Article. J Clin Oncol 2007; 25(5): 579-86.
Sehn LH, Donaldson J, Chhanabhai M, et al. Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol 2005; 23: 5027-33.
Maloney DG. Anti CD20 antibody therapy for B-cell lymphomas. N Engl J Med 2012; 366: 2008-16.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology, Non-Hodgkin’s Lymphomas, Version 4. 2013.
Candelaria-Hernández M, Cervera-Ceballos E, Meneses-García A, et al. Guías Nacionales de Diagnóstico y Tratamiento de Linfoma No Hodgkin. Rev Invest Clin 2013; 65(s2): s5-s26.
Habermann TM, Weller EA, Morrison VA, et al. Rituximab- CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol 2006; 24: 3121-7.
Pfreundschuh M, Schubert J, Ziepert M, et al. German High- Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). Six versus eight cycles of by-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20+ B-cell lymphomas: a randomized controlled trial (RICOVER-60). Lancet Oncol 2008; 9: 105-16.
Ruiz-Delgado G, Gomez Almaguer D, Tarin-Arzaga Luz C, et al. Is there a benefit of adding rituximab to CHOP in the overall survival of patients with B-cell non-Hodgkin’s lymphoma in a developing country? Hematology 2012; 17: 193-7.
Aviles A, Nambo JM, Neri N, et al. Dose dense (CEOP-14 + R) in high-risk diffuse large cell lymphoma. Med Oncol 2007; 24: 85-9.
Aviles A, Nambo MJ, Castañeda C, et al. Rituximab and escalated chemotherapy in elderly patients with aggressive diffuse large-cell lymphoma: a controled clinical trial. Cancer Biother Radiopharm 2007; 22: 194-9.
Ratner L, Lee J, Tang S, et al. Chemotherapy for human immunodeficiency virus-associated non-Hodgkin’s lymphoma in combination with highly active antiretroviral therapy. J Clin Oncol 2001; 19: 2171-8.
Kaplan LD, Lee JY, Ambinder RF, et al. Rituximab does not improve clinical outcome in a randomized phase 3 trial of CHOP with or without rituximab in patients with HIV-associated non-Hodgkin lymphoma: AIDS-Malignancies Consortium Trial 010. Blood 2005; 106(5): 1538-43.
Boué F, Gabarre J, Gisselbrecht C, et al. Phase II trial of CHOP plus rituximab in patients with HIV-associated non-Hodgkin’s lymphoma. J Clin Oncol 2006; c24: 4123-8.
Little RF, Pittaluga S, Grant N, et al. Highly effective treatment of acquired immunodeficiency syndrome-related lymphoma with dose-adjusted EPOCH: impact of antiretroviral therapy suspension and tumor biology. Blood 2003; 101: 4653-9.
Sparano JA, Lee JY, Kaplan LD, et al. Rituximab plus concurrent infusional EPOCH chemotherapy is highly effective in HIV-associated B-cell non-Hodgkin lymphoma. Blood 2010; 115: 3008-16.
Dunleavy K, Wilson W. How I treat HIV-associated lymphoma. Blood 2012; 119: 3245-55.
Dunleavy K, Little RF, Pittaluga S, et al. The role of tumor histogenesis, FDG-PET, and short-course EPOCH with dosedense rituximab (SC-EPOCH-RR) in HIV-associated diffuse large B-cell lymphoma. Blood 2010; 115: 3017-24.
Goss PE, Lee BL, Badovinac-Crnjevic T, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14(5): 391-436.
Full text