Evidence-Based Treatment for Newly Diagnosed Diffuse Large-B-cell Lymphoma in an Elderly Patient_Chinese Journal of Evidence-Based Medicine

Authors：

LIN Xiufang , DONG Birong , LI Jun

West China Hospital, Sichuan University, Chengdu 610041,China;

Corresponding author：

Keywords：

Diffused large-B-cell lymphoma; Elderly patients; Evidence-based treatment

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Objective 　Methods of evidence-based medicine were used to make an individualized treatment plan concerning newly diagnosed diffuse large-B-cell lymphoma in elderly patients.
Methods 　After clinical problems were put forward, evidence was collected from MEDLINE (Jan. 1990 to Dec. 2004) and http://sumsearch.uthscsa.edu/searchform4.htm. Subject words were: NHL; aggressive non-Hodgkin’s lymphoma; diffuse large-B-cell lymphoma; chemotherapy; CHOP; rituximab; RCT; economic evaluation; older patient.
Results 　A total of 11 randomized controlled trials and 8 systematic reviews about chemotherapy regimen, and 1 systematic review about economic evaluation were identified. A rational treatment plan was made upon a critical evaluation of the data. After 5 months follow-up, the plan was proved optimal.
Conclusions 　The treatment effectiveness in newly diagnosed diffuse large-B-cell lymphoma in the elderly has been improved by an individual treatment plan according to evidence-based methods.

Citation： LIN Xiufang,DONG Birong,LI Jun. Evidence-Based Treatment for Newly Diagnosed Diffuse Large-B-cell Lymphoma in an Elderly Patient. Chinese Journal of Evidence-Based Medicine, 2005, 05(4): 347-349. doi: Copy

1.	Jaffe ES, Harris NL, Stein H, Vardiman JW. World Health Organization classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon, France: International Agency for Research on Cancer. 2001.
2.	Kimby E, Brandt L, Nygren P. A systematic overview of chemotherapy effects in aggressive non-Hodgkin’s lymphoma[J]. Acta Oncol, 2001; 40(2-3): 198-212.
3.	Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, Glick JH, Coltman CA Jr, Miller TP.Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma[J]. N Engl J Med, 1993; 328(14): 1 002-1 006.
4.	Tilly H, Lepage E, Coiffier B. A randomized comparison of ACVBP and CHOP in the treatment of advanced aggressive non-Hodgkin’s lymphoma: the LNH93-5 study[J]. Blood, 2000; 96: 832a. abstract.
5.	Kouroukis CT, Browman GP, Esmail R, Meyer RM. Chemotherapy for older patients with newly diagnosed, advanced-stage, aggressive-histology non-Hodgkin lymphoma: a systematic review[J]. Ann Intern Med, 2002; 15; 136(2): 144-152.
6.	No authors listed.Rituximab: new indication. In aggressive non Hodgkin lymphoma: benefits must be confirmed[J].Prescrire Int, 2003; 12(66): 125-126.
7.	W(o")hrer SR. Cyclophosphamide,doxorubicin,vincristine and prednisone (R-CHOP) for treatment of early-stage gastric diffuse large-B-cell lymphoma[J]. Ann Oncol, 2004;15(7): 1 086-1 090.
8.	Portlock CS. Rituximab and CHOP for elderly patients with diffuse large-B-cell lymphoma[J]. Curr Oncol Rep, 2003; 5(5): 357.
9.	Pettengell R, Linch D. Position paper on the therapeutic use of rituximab in CD20-positive diffuse large B-cell non-Hodgkins lymphoma[J]. Br J Haematol, 2003; 121(1): 44-48.
10.	Kimby E, Brandt L, Nygren P, Glimelius B; SBU-group.A systematic overview of chemotherapy effects in aggressive non-Hodgkins lymphoma[J]. Acta Oncol, 2001; 40(2-3): 198-212.
11.	Coiffier B.Immunochemotherapy: the new standard in aggressive non-Hodgkins lymphoma in the elderly[J]. Semin Oncol, 2003; 30(1 Suppl 2): 21-27.
12.	Coiffier B, Lepage E, Briere J.CHOP Chemotherapy plus Rituximab Compared with CHOP Alone in Elderly Patients with Diffuse Large-B-Cell Lymphoma[J]. N Engl J Med, 2002; 346(4): 235-242.
13.	Hannaford P. Rituximab plus CHOP for diffuse large-B-Cell lymphoma[J]. N Engl J Med, 2002; 346(23): 1 830-1 831.
14.	The International Non-Hodgkins Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkins lymphoma[J]. N Engl J Med, 1993; 329(14): 987-994.
15.	Cancer Therapy Evaluation Program. Common toxicity criteria[M], version2.0. Bethesda, Md.: National Cancer Institute, March 1998.
16.	Knight C, Hind D, Brewer N, Abbott V. Rituximab (MabThera) for aggressive non-Hodgkins lymphoma: systematic review and economic evaluation[J]. Health Technol Assess, 2004; 8(37): iii, ix-xi,1-82.
17.	Heson BD, Horning SJ, Coiffier B. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas[J]. J Clin Oncol, 1999; 17: 1 244. [Erratum,] J Clin Oncol 2000; 18: 2 351.

1. Jaffe ES, Harris NL, Stein H, Vardiman JW. World Health Organization classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon, France: International Agency for Research on Cancer. 2001.
2. Kimby E, Brandt L, Nygren P. A systematic overview of chemotherapy effects in aggressive non-Hodgkin’s lymphoma[J]. Acta Oncol, 2001; 40(2-3): 198-212.
3. Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, Glick JH, Coltman CA Jr, Miller TP.Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma[J]. N Engl J Med, 1993; 328(14): 1 002-1 006.
4. Tilly H, Lepage E, Coiffier B. A randomized comparison of ACVBP and CHOP in the treatment of advanced aggressive non-Hodgkin’s lymphoma: the LNH93-5 study[J]. Blood, 2000; 96: 832a. abstract.
5. Kouroukis CT, Browman GP, Esmail R, Meyer RM. Chemotherapy for older patients with newly diagnosed, advanced-stage, aggressive-histology non-Hodgkin lymphoma: a systematic review[J]. Ann Intern Med, 2002; 15; 136(2): 144-152.
6. No authors listed.Rituximab: new indication. In aggressive non Hodgkin lymphoma: benefits must be confirmed[J].Prescrire Int, 2003; 12(66): 125-126.
7. W(o")hrer SR. Cyclophosphamide,doxorubicin,vincristine and prednisone (R-CHOP) for treatment of early-stage gastric diffuse large-B-cell lymphoma[J]. Ann Oncol, 2004;15(7): 1 086-1 090.
8. Portlock CS. Rituximab and CHOP for elderly patients with diffuse large-B-cell lymphoma[J]. Curr Oncol Rep, 2003; 5(5): 357.
9. Pettengell R, Linch D. Position paper on the therapeutic use of rituximab in CD20-positive diffuse large B-cell non-Hodgkins lymphoma[J]. Br J Haematol, 2003; 121(1): 44-48.
10. Kimby E, Brandt L, Nygren P, Glimelius B; SBU-group.A systematic overview of chemotherapy effects in aggressive non-Hodgkins lymphoma[J]. Acta Oncol, 2001; 40(2-3): 198-212.
11. Coiffier B.Immunochemotherapy: the new standard in aggressive non-Hodgkins lymphoma in the elderly[J]. Semin Oncol, 2003; 30(1 Suppl 2): 21-27.
12. Coiffier B, Lepage E, Briere J.CHOP Chemotherapy plus Rituximab Compared with CHOP Alone in Elderly Patients with Diffuse Large-B-Cell Lymphoma[J]. N Engl J Med, 2002; 346(4): 235-242.
13. Hannaford P. Rituximab plus CHOP for diffuse large-B-Cell lymphoma[J]. N Engl J Med, 2002; 346(23): 1 830-1 831.
14. The International Non-Hodgkins Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkins lymphoma[J]. N Engl J Med, 1993; 329(14): 987-994.
15. Cancer Therapy Evaluation Program. Common toxicity criteria[M], version2.0. Bethesda, Md.: National Cancer Institute, March 1998.
16. Knight C, Hind D, Brewer N, Abbott V. Rituximab (MabThera) for aggressive non-Hodgkins lymphoma: systematic review and economic evaluation[J]. Health Technol Assess, 2004; 8(37): iii, ix-xi,1-82.
17. Heson BD, Horning SJ, Coiffier B. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas[J]. J Clin Oncol, 1999; 17: 1 244. [Erratum,] J Clin Oncol 2000; 18: 2 351.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for Newly Diagnosed Diffuse Large-B-cell Lymphoma in an Elderly Patient

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