Abstract
DLBCL is an aggressive lymphoma treated with R-CHOP. Recently, attempts have been made to improve the outcome by increasing both dose-density and intensity but there have been no benefits in terms of survival. When treating malignancies RDI is important to consider but there is little published information on DLBCL. The purpose of this study was to analyze the differential prognostic impact of RDI in two cohorts of DLBCL patients treated with R-CHOP21 or R-CHOP14. From January 2001 to August 2013 we included DLBCL patients homogenously treated with R-CHOP21 or R-CHOP14, with or without radiotherapy, at University Hospital Son Espases, Hospital Son Llatzer of Palma and Hospital del Mar of Barcelona (N = 157). In order to avoid selection bias the patients were retrospectively identified from the Pathology Department and Pharmacy registries. Median follow-up was 68 months. There was no difference in the response or survival between the two cohorts. In the R-CHOP21 group, both a reduction higher than 15% in RDI (RR 7.41) and R-IPI (RR 2.99) were independently associated with OS. However, a reduction higher than 15% in RDI (RR 4.41) was only noted for PFS. In the R-CHOP14 group, NCCN-IPI (RR 7.09) and B-symptoms (RR 5.37) for OS; AA stage III-IV (RR 6.26) and bulky disease (RR 4.05) for PFS. There was a trend towards a higher rate of RDI reduction observed in the R-CHOP14 group but it only made an impact in the R-CHOP21 group. We conclude that R-CHOP21 and R-CHOP14 are equivalent regimens in terms of response and survival, but only if RDI reductions are avoided. For patients receiving R-CHOP21 we recommend using clinical and support measures in order to avoid RDI reductions.
Highlights
DLBCL is the most common non Hodgkin lymphoma
Seventy three patients were excluded for the following reasons: not receiving rituximab (n = 29), receiving additional consolidation therapy such as autologous stem cell transplantation or rituximab maintenance (n = 25), other regimens with higher or lower intensity (n = 9), move to another center (n = 6), diagnosis at autopsy (n = 2) and other reasons (n = 2)
R-CHOP21 remains the standard of care for patients with DLBCL
Summary
DLBCL is the most common non Hodgkin lymphoma. It is an aggressive but potentially curable lymphoma [1]. Even though phase 2 studies had predicted promising results after adding rituximab to the regimen, when randomised phase 3 trials were carried out there were no shown benefits due to their higher toxicity when compared with R-CHOP[7, 8]. This has meant that R-CHOP administered every 21 days (R-CHOP21) has become the standard treatment for DLBCL patients
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