الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Clinical audits are done to evaluate and allow governing of clinical work. It is a method of investigating the care given to patients and the clinical outcome.
In this clinical audit, patients with NHL treated at Menoufia were assessed regarding response to treatment, toxicity and survival in relation to the treatment method whether containing rituximab or not.
The study included 311 patients in two arms; those who were treated with CHOP were 263 cases with median age 48 years and those who were treated with R-CHOP 48 were cases with median age 54.5 years. The median follow up period was 28 months.
Response to treatment was better in the R-CHOP arm with 91.7% complete remission compared to 58.9% in the CHOP arm (P<0.001). Moreover, cases treated with R-CHOP developed earlier CR than those treated with CHOP (37.5% and 17.9% respectively) (P<0.001).
Both treatment regimens were tolerable with comparable toxicity results except for neutropenia which was higher in the R-CHOP arm than the CHOP arm (P=0.001)
Cases that were treated with R-CHOP had median progression free survival of 38.5 months and median overall not reached while those who were treated with CHOP only had median progression
free survival of 14 months and median overall survival of 23 months.
Adding rituximab to CHOP showed better results in early and in advanced stage disease with better benefit gained in cases with advanced disease (P=0.036 and 0.001 respectively).
There was no significant relation between PFS and hepatitis C status in cases treated with CHOP (P=0.347). Cases treated with R-CHOP also showed no significant relation between PFS and hepatitis C status (P=0.489).
R-CHOP showed better results than CHOP only in terms of PFS in both normal LDH and high LDH cases with better results in the high LDH cases (P=0.014 and 0.006 respectively). Similar results were observed regarding OS with P=0.007 for normal LDH cases and 0.021 for high LDH cases.
Rituximab significantly improved the PFS for cases with different IPI scores but didn’t improve the OS for low risk IPI cases (P=0.135)
Bulky disease and B symptoms showed significantly better results by adding rituximab to CHOP. However, there was no significant relation between them and survival regardless the treatment protocol denoting that probably they don’t add more risk to the patients.
Cox regression analysis showed that cases who didn’t receive rituximab were more liable to develop relapse by 3.7 times more than those who received rituximab.
Most of the cases who received rituximab were health insurance patients and most of them didn’t start rituximab with the first cycle of chemotherapy.