Histopathological pattern of lymphomas and clinical presentation and outcomes of diffuse large B cell lymphoma: A multicenter registry based study from India

Abstract

Context: The distribution of various subtypes of lymphomas in India is different from other parts of the world. There is scarce multicentric data on the pattern and outcomes of lymphomas in India. Aims: The aim of this study is to evaluate the histopathological and the clinical pattern and treatment outcomes of lymphomas in India based on the retrospective data collected from a multicenter registry. Materials and Methods: Retrospective data was collected at 13 public and private hospitals in India for patients diagnosed with lymphoma between January 2005 and December 2009. The data collection was performed in the setting of a multicenter lymphoma registry Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Results: Non-Hodgkin′s lymphoma (NHL) constituted 83.17% and Hodgkin′s lymphoma (HL) for 16.83% of the 1733 registered and analyzed cases. Diffuse large B cell lymphoma (DLBCL) was the most common NHL (55%) followed by follicular lymphoma (11%). CHOP was the most common chemotherapy regimen administered (84%) while rituximab was used in 42.7% of those with DLBCL. Survival analysis of treatment naïve DLBCL patients (n = 791) was performed. Of these, 29% were lost to follow-up, 20% with active disease. The median follow-up in surviving patients is 31 (range: 1-88) months. Median progression-free survival (PFS) and overall survival (OS) in DLBCL patients has not reached. There was no significant difference in median PFS (69 months vs. 61 months, P = 0.1341), but OS was significant not reached (NR) vs. NR, P = 0.0012) within international prognostic index high or intermediate subgroups. Rituximab use was associated with significantly prolonged PFS (NR vs. 82 months, P = 0.0123), but not OS (NR vs. NR, P = 0.2214). Cox regression analysis in treatment naïve DLBCL patients showed a performatnce status, stage and receipt of six or more cycles of chemotherapy to be significantly associated with OS and all of the preceding plus rituximab use significantly associated with PFS. Conclusions: Our analysis confirms previous reports of distribution of lymphoma subtypes in India and suggests that patients who are able to receive the full course of chemotherapy achieve a better outcome. This indicates the importance of ensuring compliance to treatment utilizing various measures including patient and family counseling. Prospective studies are required to confirm these findings.

Keywords

Diffuse large B cell lymphoma - India - lymphoma pattern - survival

Publication History

Article published online:
19 July 2021

• References

• 1 Moskowitz C. Risk-adapted therapy for relapsed and refractory lymphoma using ICE chemotherapy. Cancer Chemother Pharmacol 2002;49 Suppl 1:S9-12.
• 2 Seow A, Lee J, Sng I, Fong CM, Lee HP. Non-Hodgkin′s lymphoma in an Asian population:1968-1992 time trends and ethnic differences in Singapore. Cancer 1996;77:1899-904.
• 3 Three year reports of Population based registries 2006-2008. Available from: http://www.ncrpindia.org/Reports/PBCR_2006_2008.aspx. [Last access date 08-Aug-2013].
• 4 Garg A, Dawar R, Agarwal V, Rustagi RK, Kochupillai V. Non-Hodgkin′s lymphoma in northern India. A retrospective analysis of 238 cases. Cancer 1985;56:972-7.
• 5 Sahni CS, Desai SB. Distribution and clinicopathologic characteristics of non-Hodgkin′s lymphoma in India: A study of 935 cases using WHO classification of lymphoid neoplasms (2000). Leuk Lymphoma 2007;48:122-33.
• 6 Naresh KN, Srinivas V, Soman CS. Distribution of various subtypes of non-Hodgkin′s lymphoma in India: A study of 2773 lymphomas using R.E.A.L. and WHO Classifications. Ann Oncol 2000;11 Suppl 1:63-7.
• 7 Chakrabarti S, Sarkar S, Goswami BK, Mondal S, Roy A, Das S. Hodgkin′s and Non-Hodgkin′s lymphomas in an indian rural medical institution: Comparative clinicopathologic analysis. Asian Pac J Cancer Prev 2010;11:1605-8.
• 8 Naresh KN, Agarwal B, Sangal BC, Basu DD, Kothari AS, Soman CS. Regional variation in the distribution of subtypes of lymphoid neoplasms in India. Leuk Lymphoma 2002;43:1939-43.
• 9 Armitage JO, Weisenburger DD. New approach to classifying non-Hodgkin′s lymphomas: Clinical features of the major histologic subtypes. Non-Hodgkin′s Lymphoma Classification Project. J Clin Oncol 1998;16:2780-95.
• 10 Morrison VA. Evolution of R-CHOP therapy for older patients with diffuse large B-cell lymphoma. Expert Rev Anticancer Ther 2008;8:1651-8.
• 11 Khera R, Jain S, Kumar L, Thulkar S, Vijayraghwan M, Dawar R. Diffuse large B-cell lymphoma: Experience from a tertiary care center in North India. Med Oncol 2010;27:310-8.
• 12 Prakash G, Sharma A, Raina V, Kumar L, Sharma MC, Mohanti BK. B cell non-Hodgkin′s lymphoma: Experience from a tertiary care cancer center. Ann Hematol 2012;91:1603-11.
• 13 Biswas G, Parikh PM, Nair R, Bhagwat R, Bakshi A, Prabhash K, et al. Rituximab (anti-CD20 monoclonal antibody) in lymphoproliferative malignancies: Tata Memorial experience. J Assoc Physicians India 2006;54:29-33.
• 14 Coiffier B, Thieblemont C, Van Den Neste E, Lepeu G, Plantier I, Castaigne S, et al. Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: A study by the Groupe d′Etudes des Lymphomes de l′Adulte. Blood 2010;116:2040-5.
• 15 Pfreundschuh M, Kuhnt E, Trümper L, Osterborg A, Trneny M, Shepherd L, et al. CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma:6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group. Lancet Oncol 2011;12:1013-22.