Non-Hodgkin lymphoma treatment in middle-income countries in Latin America: perspective of the Latin American Study Group of Lymphoproliferative Disorders [Grupo de Estudio de Linfoproliferativos de Latino América (GELL)]

Figures & data

Table 1. Countries distributed according to their annual income per person.

Income Level	Country	Income in U.S. dollars
Low-Middle income	Belize, Bolivia, El Salvador, Haiti, Nicaragua.	1047.00–4095.00
Upper-Middle income	Argentina, Brazil, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Guatemala, Jamaica, Mexico, Paraguay, Peru.	4096.00–12,695.00
High income	Antigua-Barbuda, Aruba, Bahamas, Barbados, Bermuda, Britis Virgen Islands, Canada, Chile, Puerto Rico, Trinidad & Tobago, Uruguay, United States.	>12,695.00

Source: Data from World Bank. https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=ZJ.

Figure 1. (a) Age-standardized rate of non-Hodgkin lymphoma incidence in 2020 according to annual income per person/country. (b) Age-standardized rate of non-Hodgkin lymphoma prevalence in 2020, according to annual income per person/country. Age range:  ≥ 15 years in both (incidence and prevalence). Data Source: Globocan [1] http://gco.iarc.fr/today.

Figure 2. The overall survival (OS) Kaplan-Meier curve. (a) OS curve of 1369 patients with DLBCL, median 5-year OS survival: 56%. (b) OS comparing R-CHOP vs. CHOP (60% vs. 48%, respectively; p < 0.0001). (c) OS comparing all the different regimens: R-CHOP (n = 997), 60% OS at 5 years. Intensive Therapy (n = 32) (R-EPOCH, R-Hyper-CVAD, R-DHAP, R-ICE as first line treatment), 63% OS at 5 years. R-mini-CHOP (n = 62), 55% OS at 5 years. CHOP (n = 113), 48% OS at 5 years. Others (n = 20) (R-Bendamustine, R-High-Dose Methotrexate, radiotherapy alone, rituximab alone), 45% OS at 5 years. R-CVP (n = 84), 25% OS at 5 years. CVP (n = 20), 14% OS at 5 years. No treatment (n = 41), 0% OS at 5 years. (d) OS survival in very elderly patients (≥80 years old) based on different regimens: R-CHOP (n = 65), 56% OS at 3 years. R-mini-CHOP (n = 17), 52% OS at 3 years. R-CVP (n = 23), 30% OS at 3 years. CVP (n = 5), 20% OS at 3 years. CHOP (n = 9), 0% OS at 3 years. Others (n = 4) (R-bendamustine, radiotherapy alone and rituximab alone), 0% OS at 3 years. No treatment (n = 11), 0% OS at 3 years. Notes: R, rituximab; CHOP: Cyclophosphamide, doxorubicin, vincristine, prednisone; EPOCH: Etoposide, vincristine, and doxorubicin in continuous 24 hr. infusion of cyclophosphamide one day and prednisone 5 days, all adjusted according to the absolute neutrophil count before each cycle. Hyper-CVAD: high-dose doxorubicin and cyclophosphamide, vincristine, dexamethasone. DHAP: dexamethasone, high-dose cytarabine, platinum-based drug. ICE: ifosfamide, carboplatin, etoposide. CVP: cyclophosphamide, vincristine, prednisone. R-mini-CHOP: 50% decrease in cyclophosphamide and doxorubicin doses.

Table 2. Comparison of Cox hazards ratio between the different treatment regimens in the DLBCL cohort.

Regimen	Hazards Ratio	Confidence Interval 95%	P-value
R-CHOP vs. CHOP	0.53	0.40–0.70	0.019
R-CHOP vs. R-CVP	0.37	0.25–0.54	0.005
R-CHOP vs. CVP	0.24	0.10–0.57	0.002
R-CHOP vs. Intensive regimen	1.03	0.61–1.73	0.28
R-CHOP vs. others	0.55	0.26–1.15	0.55
R-CHOP vs. R-mini-CHOP	0.77	0.52–1.14	0.77

Notes: R: rituximab; CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone. CVP: cyclophosphamide, vincristine, prednisone. Intensive regimen: EPOCH: Etoposide, vincristine, and doxorubicin in continuous 24 h. infusion in the same bag, cyclophosphamide one day and prednisone for 5 days. Hyper-CVAD: high-dose doxorubicin and cyclophosphamide, vincristine, dexamethasone. DHAP: Dexamethasone, high-dose cytarabine, platinum-based drug. ICE: ifosfamide, carboplatin, etoposide. Others: R-bendamustine, radiotherapy alone, and rituximab alone. R-mini-CHOP: 50% decrease in cyclophosphamide and doxorubicin doses.

Globocan. Data source from international agency for research on cancer. 2020. Available from: http://gco.iarc.fr.

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