Thread by @AaronGoodman33

Early stage DLBCL Tweetorial of all key trials from a presentation I just gave
#Goodman_heme
See last slide/Tweet for my conclusions

SWOG 8736:
>18 years
Bulk (>10 cm) allowed
CHOPx 3+IFRT vs. CHOP x 3 +IFRT
OS⬆️with IFRT but no difference in OS with extended f/u

18 year f/u

ECOG 1484
>16 years
Bulk (>10 cm) allowed
CHOP x 8 if CR (by CT) randomized to IFRT vs observation
DFS improved with IFRT
No difference in OS

GELA/LNH 93-1
No adverse risk factors on aaIPI
Age <60 years
Bulk (> 10 cm) allowed
ACVBP x 3 vs CHOP x 3 + IFRT
EFS and OS improved with chemo alone
Very young favorable group but chemo alone works!

GELA/LNH 93-4
>60 years
No adverse risk factors on aaIPI
Bulk (>10 cm) allowed
CHOP x 4 vs CHOP x 4 +IFRT
No difference in EFS or OS
Chemo alone works

UNFOLDER
18-60 years
65% stage I/II
aaIPI 0 with bulk or 1🚫 bulk
Bulk allowed (>7.5 cm)
RCHOP21x6 vs RCHOP21x6 + IFRT vs RCHOP14 x 6 vs RCHOP14x6 + IFRT
⬆️EFS in IFRT, no difference in PFS/OS
EFS in patients no IFRT was linked to higher rate of PRs triggered additional Rx (XRT)

LYSA/GOELAMS 02-03
No bulk allowed (>7 cm)
RCHOP14 x 4 then PET/CT
IF CR on PET2 then
mIPI 0 observation
mIPI>0 RCHOP x 2
If PR on PET2 then
RCHOP14 x 2 + IFRT
No difference on EFS/OS between no XRT and RT

FLYER
No bulk (>7.5 cm)
aaIPI 0
RCHOP x 6 vs. RCHOP x 4 +R x2
No difference is PFS/OS
Chemoimmunotherapy alone works for very favorable early stage DLBCL

SWOG 1001
Any mIPI
No bulk (>10 cm)
RCHOP x 3 then PET/CT
If CR then RCHOP x 1
If PR then IFRT followed by Zevalin
5 PFS/OS the same

My conclusions I/II DLBCL

SWOG8736: CHOPx3 + IFRT = CHOPx8
GELA/LNH 93-1: Intensive chemo>CHOP/XRT for young fav dz, but toxic
GELA/LNH93-4: CHOPx4 = CHOPx4+IFRT for old fav dz
FLYER: RCHOPx6 = RCHOPx4 for young fav dz
SWOG1001: If PET2 CR after RCHOPx3 then IFRT may be avoided