Response of CHOP in Diffuse Large B Cell Lymphoma * A Single Center Experience from Pakistan Muhammad Kashif, Muhammad Usman Shaikh, Muhammad Adnan Qureshi, Salman Naseem Adil and Mohammad Khurshid Affiliation: Department of Pathology and Microbiology, Aga Khan University, Stadium Road, Karachi, Pakistan ABSTRACT INTRODUCTION Diffuse large B cell lymphoma is the most common subtype of non-Hodgkin’s lymphomas with cyclophosphamide, doxorubicin, Oncovin, and prednisolone (CHOP) as its standard chemotherapy. OBJECTIVES The objectives of the study are to evaluate the response of six cycles of CHOP chemotherapy in Diffuse large B cell lymphoma (DLBCL) with analysis of its various prognostic factors influencing the outcome. MATERIALS & METHODS This was a prospective cross-sectional study conducted at Aga Khan University Hospital Pakistan from May 2, 2005 to December 31, 2006. We enrolled 50 patients after their informed consent. Their pretreatment laboratory and radiological investigations were carried out. Six cycles of CHOP chemotherapy were administered on 21-day intervals. Response was evaluated clinically as well as on posttreatment radiological and laboratory workup. RESULTS Among 50 patients, 41 were available for response assessment. Complete response, partial response, and treatment failure were observed in approximately 46%, 37%, and 17% of patients, respectively. An advanced stage of disease, high LDH level, and low hemoglobin levels were found to be negatively associated with the response. CONCLUSIONS CHOP is an effective treatment for DLBCL. Stage, LDH level, and hemoglobin levels can influence the response of chemotherapy. Keywords: diffuse large B cell lymphoma, CHOP, response Correspondence: Muhammad Kashif, Department of Pathology and Microbiology, Aga Khan University, Stadium Road, Karachi-74800, Pakistan. Tel: (92)-21-4861557; Fax: (92)-21-4934294; e-mail: kashif.khan@aku.edu INTRODUCTION Diffuse large B cell lymphoma (DLBCL) is the most common NHL representing 3040% of all cases in the North America [1, 2]. It is characterized by aggressive clinical behavior with rapidly enlarging lymphadenopathy as its typical manifesta- tion. DLBCL was grouped as the diffuse large cell cleaved, noncleaved, immunoblastic, or a mixture of both cell types under a Working Formulation. Later, it was labeled as a diffuse large B cell lymphoma in Revised European American Lymphoma (REAL) classification. More recently, the World Health Organization (WHO) classification has included DLBCL under the heading of mature B cell neoplasm [3, 4]. Presentation in most cases of DLBCL is acute with a rapidly enlarging abdominal or cervical mass. In one-third of these cases this is usually associated with fever, weight loss, or night sweats. Moreover approximately half of the pati- ents present with elevated lactate dehydrogenase (LDH) levels [1, 5]. All patients presenting with diffuse large B cell lymphoma should be treated with curative intent that can be anticipated in 40 to 50% of these patients [6]. CHOP (cyclophosphamide, doxorubicin, oncovin, and prednisolone) is the standard chemotherapy for diffuse large B cell lymphoma [7]. Various trials comparing CHOP with other combination chemothera- pies were conducted but there is no clear advantage observed of these regimens over CHOP, which remains the gold standard treatment for a patient with diffuse large B cell lymphoma [79]. Newer immunological modalities have been established with promising results but usually are used in addition to the standard chemotherapy [4]. Autologous stem cell transplants following a high dose chemotherapy is superior to chemother- apy alone in disseminated aggressive lymphomas [10]. Although a large number of studies examining treatment outcomes in a patient with NHL have been conducted, almost all have various NHL histologies. Until now there are relatively few reports restricted specifically to diffuse large B ASIA-PACIFIC JOURNAL OF ONCOLOGY & HEMATOLOGY REVIEW ARTICLE APJOH 2010; 000:(000). Month 2010 1 www.slm-oncology.com