2. Background Diffuse large B-cell lymphoma (DLBCL) is the most commonly occurring lymphoma in the Western world. It’s account for about one-third of all lymphomas in adults DLBCLs are clinically, biologically, and pathologically heterogeneous with biologically distinct subtypes that have different expected treatment outcomes. The rituximab has been registered in Europe since 1998. since the introduction of rituximab (RCHOP) in TTT of DLBCL a revolutionary improvement in treatment outcome was achieved, especially in the low risk group according to IPI. In our unit the RCHOP become the standard of TTT since 2009 Treatment strategies for patients with diffuse large B-cell lymphoma: Blood and Lymphatic Cancer: Targets and Therapy 2012:2 87–98

3. Purpose To analyze the outcome of patients with DLBCL treated by RCHOP regimen in our unit

4. Patients and Methods Population: - Newly diagnosed untreated patients with nodal DLBCL aged ≥18y, who received a minimal of 3 RCHOP21. during the period from Novembre 2009 until June 2011 (20months) The diagnosis : - on the basis of excisional lymph node or tissue biopsy according to WHO criteria 2008 - IHC : CD20, CD3, CD5, CD10, bcl2, bcl6, MUM1, Ki67 Staging comprised clinical examination, thoracic and abdominal computed tomography scans Bone marrow biopsy

5. Patients and methods CBC,routine blood chemistry LDH, protein electrophoresis, renal and liver function Echocardiography in patient with a history of cardiac disease or older Viral screening test : HVC,HVB,HIV Prognostic factor according IPI, aaIPI The response evaluation :abnormal radiological tests at baseline were repeated after 3to 4 cycles and after the last cycle of treatment, the bone marrow biopsy was repeated in the end of TTT if initially involved The OS and EFS were performed by Kaplein Meyer method Data were analyzed using Epi info system.

6. Patients and methods patients were excluded : - extranodal localisation, - less than 3 RCHOP - TTT CHOP

7. Distribution of NHL per year

8. 169 patients were assigned from Nov 2009 until june2011 - 83 nodal 49% : 12 CHOP 19 lost befor TTT 52 RCHOP - 86 extranodal

10. Geographic distribution

11. Epidemiological characteristics Patients included52 Mean age52,3 years (range 25-77 y) Sex-ratio M/F1.2

12. Distribution by age and sex group :

13. Clinical features the mean delay of diagnosis6 months (range 1-12) B symptoms30 patients (58%) HVC +4 patients (8%) venous thrombosis at diagnosis. 1 patient (2%)

14. Localization SitesNb% Lymph nods4077% Tonsil1019% Cavum24%

15. Ann –Arbor staging : StageNb% I815% II1835% III2038% IV612%

16. Score IPI IPIRiskNb% 0Low risk1529% 1Low intermediate1427% 2Hight intermediate1834% > 2Hight risk510%

17. Treatment - the mean delay before treatment : 26 days (1-120) - the mean nb of RCHOP : 6 cycles (3-8 )

18. Treatment 52 pts 1 death under TTT (2%) 46 CR (88%) 9 relapses (17%) 3 under TTT6 deaths 37 CR (71%) 1 death lung fibrosis 36 MCR (69%) 5 failure (10%) 2 deaths after RDHAP 3 deaths after failure

19. Failure, death and relapses charactéristics: AgeSex ratioMean delay of relapse StageIPIMean Delay befor TTT 5/9 ≥60 Y 0,63 months7 advanced stage 7 unfavorable IPI 28 days Response Age Sex-ratio StageIPIRemarks Death65MIIIA unfavorableComorbidities Faillure3/5 <60y h/f 0.7 3/5 advanced stage 3/5 unfavorable 2 HVC + Relapses 5/9 ≥60 Y 0.6 7 advanced stage 7 unfavorable

20. 69%

21. <60 ans: 75% ≥60 ans : 60%

22. 59%

23. <60 years old :73% ≥60 years old : 39%

24. 88% 48% 83% 31%

25. Conclusion The DLBCL is the most common subtype of NHL in our unit approximatively 50% of all lymphomas. The mean age at diagnosis is 52 y, pic incidence in younger patients. 44 % of patients with unfavorable IPI Good response in younger patients Vs elderly patients Relapases are more frequent in : elderly patients, advanced stage and unfavorabl IPI.

26. Conclusion Gene expressing profiling Intensive therapy with ASCT for advanced stage and refractory disease improve the supportive care PET scan is available but not accessible for all patients We should focus on decreasing the relapse rate without increasing toxicity in elderly patients. The interest of a codified protocol