Outcome of Patients with Diffuse Large B Cell Lymphoma Treated in a Tertiary Care Centre in Uae; A Retrospective Review

Background:

Diffuse large B cell lymphoma is the most frequent Haematological Malignancy in UAE. DLBC lymphoma treatment and outcome are well established. Most of reported outcome data is from North America or Europe. Because of lack of reported literature from Middle East, a retrospective data collection and review was performed in Tawam Hospital to evaluate the outcome of DLBC lymphoma.

Methods:

Retrospective chart review of all diffuse large B cell lymphoma patients treated from January 1, 2008 till December 30, 2012 at Tawam Hospital, a Tertiary Care Oncology Centre in UAE.

Results:

A total of 99 patients were identified with diffuse large B cell lymphoma. The median age was 48 (17 to 85). 59% of patients were male with a male to female ratio of 1.4. There were 17 (17%) stage I cases, 27 (27%) stage II cases, 23 (23%) stage III cases, and 30 (30%) stage IV cases. The stage was not documented in 2 (2%) patients. International Prognostic Index (IPI) score was documented in 80 (80%) patients. 28 (35%) of patients had low IPI score (0 or 1 risk factor), 33 (41%) patients had low intermediate IPI score (2 risk factor), 8 (10%) patients had high Intermediate IPI score (3 risk factors) and 11 (14%) patients had high IPI score (4 and 5 risk factors). 88 (89%) patients completed planned treatment: either R-CHOP or R-CHOP like chemotherapy. Involved field radiation therapy (IFRT) was given in limited stage and bulky disease. 11 (11%) patients didn't have a complete treatment. 3 patients received only R-CVP, 4 patients received only 1 cycle R-CHOP, 1 patient did not receive any treatment, 1 patient received only palliative Radiotherapy, 1 patient received Rituximab and palliative RT and 1 patient received only Dexamethasone and Rituximab.

Relapse-free patients had median follow up of 31 months (1 to 67). 19 (26%) had less than 12 months follow up after completion of chemotherapy. Patients with documented relapses or primary refractory disease had relapse or progression at a median follow up of 14 month (1 to 43). There were 3 (10%) relapses in Low IPI score, 8 (24%) in low intermediate group, 4 (50%) in high intermediate group and 6 (54%) in high risk group.

Discussion:

Our data showed more young patients, median age 48, as compared to SEER data median age 65 and male predominance (59%), slightly higher as compared to SEER data (55%). These findings may be related to the demographics of UAE. UAE relatively have young and male predominance partly due to large number of expatriate population.

Distribution of IPI score in our data is different as compared to the reported data; low risk 35% vs 52%, low intermediate 41% vs 21%, high intermediate 10% vs17%, and high risk 14% vs10%. Our data is missing reporting of IPI score in 20% of cases, may explain party the above difference.

As median follow up of patient without relapse was 34 months, so comparison was made with 3 years progression free survival data reported in literature. Relapse free survival in the Low risk group 90% is comparable to reported 3 years progression free survival of 87% , low intermediate 76% as compared to reported 75%, in High intermediate and High risk group 50% and 46% are close to reported 59% (3) and 50% . The difference in high intermediate and high risk group as compared to reported survival in literature may be due to small number of patients in these groups.

Conclusion:

Outcome of DLBC lymphoma in our single centre retrospective review is relatively similar to reported outcome in literature. Median age is lower as compared to SEER data.