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interests The authors declare that they have no competing interests. Authors’ contributions SM, GA, MB and VL conceived of the study and partecipated in its design and coordination. BS, MGP, SG and SA contributed with the enrollement of patients, were responsible of the radiotherapy treatments and collected the patient’s clinical data. SM and VL performed the radiobiological modelling and the statistical analyses, and wrote the manuscript. All authors read and approved the final draft.”
“Background Aggressive lymphoma

is known to be a highly chemosensitive NVP-HSP990 ic50 disease. Therefore, over the past few decades, constant attempts have been made to develop various types of combination chemotherapy including first generation combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) [1]. However, particularly in patients with aggressive lymphoma in the higher International Prognostic Index (IPI) risk group, satisfactory outcomes have not been achieved, with a five-year survival of less than 50% [2]. Several retrospective studies demonstrated that the relative dose intensity (RDI) of combination chemotherapy significantly influences survival in aggressive lymphoma [3–7]. Moreover, rituximab, a chimeric NU7026 in vitro monoclonal anti-CD20 antibody combined with CHOP chemotherapy (R-CHOP) has improved outcome in patients Tenoxicam with diffuse

large B-cell lymphoma (DLBL) [8, 9]. Rituximab has direct, complement-dependent and antibody-dependent cellular cytotoxicity against B-cells. The drug also sensitizes B-lymphoma cells to chemotherapy [10]. Therefore, a combined approach with rituximab plus CHOP could conceivably modify the effects of RDI. However, there is no evidence that even in combination chemotherapy with rituximab that higher RDI improves the outcome for aggressive B-cell type lymphoma. Hence, in our study, we retrospectively analyzed the impact of the RDI of chemotherapy with R-CHOP as an initial treatment on the survival of patients with DLBL, and furthermore, we determined the factors influencing RDI. Methods Eligibility Patients were eligible if they had newly diagnosed DLBL according to the World Health Organization classification or the Revised European-American Lymphoma classification [11, 12]. As initial chemotherapy, they received R-CHOP with more than three consecutive courses between December 2003 and February 2008 at five institutions, Osaka City University Hospital, Osaka City General Hospital, Seichokai Fuchu Hospital, Saiseikai Nakatu Hospital and Wakakoukai Hospital. One hundred patients who had complete records of drug dose, time intervals, and prophylactic G-CSF use were deemed eligible for this study.