International Journal of Hematology

DOI: 10.1007/s12185-009-0259-8 Pages: 326-331

The effect of adding rituximab to CHOP-based therapy on clinical outcomes for Japanese patients with diffuse large B-cell lymphoma: a propensity score matching analysis

1. Okayama University Hospital, Division of Hematology and Oncology

2. Aichi Cancer Center Research Institute, Division of Epidemiology and Prevention

3. Ehime Prefectural Central Hospital, Department of Hematology-Oncology

4. National Hospital Organization Okayama Medical Center, Department of Hematology

5. Kochi Medical School, Department of Hematology and Respiratory Medicine

6. Kochi Medical Center, Department of Hematology

7. Kobe Nishi City Hospital, Department of Hematology and Immunology

8. Kagawa Rosai Hospital, Department of Internal Medicine

9. Okayama Rosai Hospital, Department of Hematology

10. Sumitomo-Besshi Hospital Cancer Center, Department of Internal Medicine

11. Chugoku Central Hospital, Department of Internal Medicine

12. National Hospital Organization Minami-Okayama Medical Center, Department of Hematology

13. Saiseikai Nakatsu Hospital, Department of Internal Medicine

14. Kure Kyosai Hospital, Department of Internal Medicine

15. Okayama University Hospital, Division of Pathology

Correspondence to:
Mitsune Tanimoto
Tel: +81-86-2357227
Fax: +81-86-2328226



We conducted a retrospective analysis to evaluate the impact on clinical outcomes of adding rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) treatment for diffuse large B-cell lymphoma (DLBCL) patients in Japan. A propensity score method was used to compensate for the non-randomized study design. From January 2000 to December 2004, 378 patients who were newly diagnosed with DLBCL at 13 institutes were enrolled: 123 in the rituximab plus CHOP-based chemotherapy (R+) group, and 255 in the CHOP-based chemotherapy only (R−) group. The complete response rate was significantly higher in the R+ group than in the R− group (77.7 vs. 69.4%, P < 0.001). The progression-free survival (PFS) at 2 years was 62.4% in the R+ group and 57.0% in the R− group. The 2-year overall survival (OS) was 76.9% for the R+ group and 70.5% for the R− group. A multivariate analysis revealed that the addition of rituximab was a strong independent prognostic factor for PFS (hazard ratio 0.64, 95% CI 0.43–0.96, P = 0.031). A subgroup analysis revealed that R+ particularly benefited younger patients (hazard ratio 0.25, 95% CI 0.08–0.75, P = 0.013). IPI also showed significant impact for PFS (hazard ratio 1.82, 95% CI 1.55–2.14 for one score increase, P < 0.001) as well as OS (hazard ratio 2.10, 95% CI 1.71–2.57, P < 0.001). In summary, the addition of rituximab to CHOP-based chemotherapy results in better outcomes for Japanese DLBCL patients, particularly younger patients.

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