Article ; Online: R-miniCHOP versus R-CHOP in elderly patients with diffuse large B-cell lymphoma: A propensity matched population-based study.
American journal of hematology
2023 Volume 99, Issue 2, Page(s) 216–222
Abstract: ... immunotherapy strategy of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-miniCHOP ... was introduced as a treatment option as from 2014 onward in the Netherlands. Although R-miniCHOP is ... more tolerable, reduction of chemotherapy could negatively affect survival compared to R-CHOP. The aim ...
| Abstract | For elderly frail patients with diffuse large B-cell lymphoma (DLBCL), an attenuated chemo-immunotherapy strategy of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-miniCHOP) was introduced as a treatment option as from 2014 onward in the Netherlands. Although R-miniCHOP is more tolerable, reduction of chemotherapy could negatively affect survival compared to R-CHOP. The aim of this analysis was to assess survival of patients treated with R-miniCHOP compared to R-CHOP. DLBCL patients ≥65 years, newly diagnosed in 2014-2020, who received ≥1 cycle of R-miniCHOP or R-CHOP were identified in the Netherlands Cancer Registry, with survival follow-up through 2022. Patients were propensity-score-matched for baseline characteristics. Main endpoints were progression-free survival (PFS), overall survival (OS), and relative survival (RS). The use of R-miniCHOP in DLBCL increased from 2% in 2014 to 15% in 2020. In total, 384 patients treated with R-miniCHOP and 384 patients treated with R-CHOP were included for comparison (median age; 81 years, stage 3-4; 68%). The median number of R-(mini)CHOP cycles was 6 (range, 1-8). The 2-year PFS, OS and RS were inferior for patients treated with R-miniCHOP compared to R-CHOP (PFS 51% vs. 68%, p < .01; OS 60% vs. 75%, p < .01; RS 69% vs. 86%, p < .01). In multivariable analysis, patients treated with R-miniCHOP had higher risk of all-cause mortality compared to patients treated with R-CHOP (HR 1.73; 95%CI, 1.39-2.17). R-miniCHOP is effective for most elderly patients. Although survival is inferior compared to R-CHOP, the use of R-miniCHOP as initial treatment is increasing. Therefore, fitness needs to be carefully weighed in treatment selection. |
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| MeSH term(s) | Humans ; Aged ; Rituximab ; Antibodies, Monoclonal, Murine-Derived/adverse effects ; Vincristine/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Doxorubicin/adverse effects ; Cyclophosphamide ; Lymphoma, Large B-Cell, Diffuse ; Prednisone/adverse effects ; Treatment Outcome |
| Chemical Substances | Rituximab (4F4X42SYQ6) ; Antibodies, Monoclonal, Murine-Derived ; Vincristine (5J49Q6B70F) ; Doxorubicin (80168379AG) ; Cyclophosphamide (8N3DW7272P) ; Prednisone (VB0R961HZT) |
| Language | English |
| Publishing date | 2023-11-28 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 196767-8 |
| ISSN | 1096-8652 ; 0361-8609 |
| ISSN (online) | 1096-8652 |
| ISSN | 0361-8609 |
| DOI | 10.1002/ajh.27151 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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