Impact of Omission/Reduction of Vincristine From R-CHOP in Treatment of DLBCL.

Abstract

BACKGROUND:

The R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is the standard therapy for patients with diffuse large B-cell lymphoma (DLBCL). However, vincristine is sometimes omitted or reduced owing to side effects.

MATERIALS AND METHODS:

We retrospectively reviewed newly diagnosed patients with DLBCL with R-CHOP-like chemotherapy in our institute from January 2005 to February 2018 to investigate whether the omission/reduction of vincristine reduced the efficacy of the treatment. We compared the overall survival (OS) with and without the omission/reduction of vincristine from the R-CHOP regimen.

RESULTS:

A total of 576 cases were reviewed, and vincristine was omitted/reduced in 50 (9%) patients. The 4-year OS with and without vincristine omission/reduction for relative dose intensity < 80%, 50%, and 25% was 70% versus 82% (P = .035), 70% versus 82% (P = .085), and 53% versus 82% (P = .0007). In a multivariate analysis, adjusting for international prognostic index risk factors, a statistically significant, poor OS was indicated in the patients with relative dose intensity < 25%.

CONCLUSIONS:

Excessive dose omission/reduction of vincristine might lead to a substantial loss of efficacy of R-CHOP therapy.

• Authors: Shoko Marshall, Noriko Nishimura, Norihito Inoue, Hirofumi Yamauchi, Naoko Tsuyama, Kengo Takeuchi, Yuko Mishima, Masahiro Yokoyama, Toshie Ogasawara, Naoki Mori, Tetsuya Ogawa, Hiroshi Sakura, Yasuhito Terui
• Journal: Clinical lymphoma, myeloma & leukemia (Clin Lymphoma Myeloma Leuk) Vol. 21 Issue 3 Pg. 162-169 (03 2021) ISSN: 2152-2669 [Electronic] United States
• PMID: 33483276 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.

Chemical References

• R-CHOP protocol
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Clinical Decision-Making
• Cyclophosphamide (adverse effects, therapeutic use)
• Disease Management
• Doxorubicin (adverse effects, therapeutic use)
• Female
• Humans
• Lymphoma, Large B-Cell, Diffuse (diagnosis, drug therapy, etiology, mortality)
• Male
• Middle Aged
• Neoplasm Staging
• Prednisone (adverse effects, therapeutic use)
• Prognosis
• Rituximab (adverse effects, therapeutic use)
• Survival Analysis
• Treatment Outcome
• Vincristine (adverse effects, therapeutic use)
• Young Adult