R-CHOP appears to be the best first-line treatment for second primary diffuse large B cell lymphoma: a cancer registry study

Second primary diffuse large B cell lymphoma (spDLBCL) is defined as a metachronous tumor occurring after a first primary cancer. To date, while R-CHOP is the standard first-line treatment for de novo DLBCL, no available data show that R-CHOP is the optimal treatment for spDLBCL. This exploratory st...

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Bibliographic Details
Published in:	Annals of hematology Vol. 99; no. 7; pp. 1605 - 1613
Main Authors:	Systchenko, T., Defossez, G., Guidez, S., Laurent, C., Puyade, M., Debiais-delpech, C., Dreyfus, B., Machet, A., Leleu, X., Delwail, V., Ingrand, P.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2020 Springer Nature B.V
Subjects:	Cancer Chemotherapy Health risk assessment Hematology Lymphoma Medicine Medicine & Public Health Oncology Original Article Diffuse large B cell lymphoma Prior chemotherapy R-CHOP Second primary neoplasms
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Summary:	Second primary diffuse large B cell lymphoma (spDLBCL) is defined as a metachronous tumor occurring after a first primary cancer. To date, while R-CHOP is the standard first-line treatment for de novo DLBCL, no available data show that R-CHOP is the optimal treatment for spDLBCL. This exploratory study aimed to investigate treatment of spDLBCL. From 2008 to 2015, the Poitou-Charentes general cancer registry recorded 68 cases of spDLBCL ≤ 80 years old, having received a first-line treatment with either R-CHOP (78%) or other regimens (22%). Patients without R-CHOP have worse overall survival in univariate (HR 2.89 [1.33–6.24], P = 0.007) and multivariate (HR 2.98 [1.34–6.67], P = 0.008) analyses. Patients without R-CHOP more frequently had PS > 1 (67% vs. 28%, P = 0.007) and prior chemotherapy (60% vs. 26%, P = 0.02), which suggests that both of these factors influence a clinician’s decision to not use R-CHOP. Prior chemotherapy had no prognostic impact in univariate and multivariate analyses; this result could call into question the risk-benefit balance of not using R-CHOP to prevent toxicity. In our study, one DLBCL out of ten occurred after a first primary cancer, and as regards de novo DLBCL, R-CHOP appeared to be the best first-line treatment. Larger series are needed to confirm these results.
ISSN:	0939-5555 1432-0584
DOI:	10.1007/s00277-020-04100-8