Limited-Stage Diffuse, Large B-Cell Lymphoma (Dlbcl) Patients With A Negative Pet Scan Following Three Cycles Of R-Chop Can Be Effectively Treated With Abbreviated Chemoimmunotherapy Alone

Four cycles of CHOP chemotherapy has been shown to be sufficient treatment for low-risk elderly patients with limited-stage DLBCL, eliminating the need for radiation therapy (Bonnet et al, JCO 2007). FDG-PET scanning is an effective prognostic tool that may identify chemo-sensitive patients (regardless of age or clinical risk factors) who can appropriately be treated with abbreviated chemoimmunotherapy alone. Patients: Beginning in 2005, we have recommended that all prospective patients with limited-stage DLBCL (stage I/II, no B-symptoms, mass < 10cm) treated in British Columbia (BC) undergo a PET scan following 3 cycles of R-CHOP; PET-negative patients should then receive one additional cycle of R-CHOP (total 4 cycles R-CHOP), while PET-positive patients receive involved-field radiation therapy (IFRT). Clinical characteristics of the first 50 patients are as follows: median age 67 y (range 31–88); 56% male; 62% stage I, 38% stage II; 4% PS>1; 6% elevated LDH; 58% at least 1 extranodal site, 10% >1 extranodal site. Stage-modified IPI risk factors: 22% 0; 70% 1–2; 8% 3–4. Median follow-up is 17 mos (range 4–26).