Addition of rituximab to reduced-dose CHOP chemotherapy is feasible for elderly patients with diffuse large B-cell lymphoma

Ho-Jin Shin, Joo Seop Chung, Moo-Kon Song, Seon-Kyeong Kim, Sangmin Choe, Goon-Jae Cho
Cancer Chemotherapy and Pharmacology 2012, 69 (5): 1165-72

PURPOSE: The aim of this study was to evaluate the efficacy and toxicity of reduced-dose (RD) RCHOP (rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy for elderly patients with diffuse large B-cell lymphoma (DLBCL).

METHODS: This study comprised 85 patients, aged ≥ 60 years, who were diagnosed with DLBCL; patients were enrolled at a single center between June 2004 and December 2009. Patients received either 6 or 8 cycles of RD-RCHOP, spaced 3 weeks apart, at the physician's discretion. The RD-RCHOP regimen consisted of 375 mg/m(2) rituximab, 600 mg/m(2) cyclophosphamide, 30 mg/m(2) doxorubicin, and 1-mg vincristine on day 1 of each cycle, and 40-mg prednisone on days 1-5. The patients received granulocyte colony-stimulating factor if they experienced grade 4 neutropenia or febrile neutropenia during any cycle.

RESULTS: The average relative dose intensity was 97.3% for doxorubicin and 97.4% for cyclophosphamide. The complete remission (CR) and overall response rate were 67.1 and 89.5%, respectively. The 3-year event-free survival and overall survival rates were 71.9% ± 5.1% and 83.3% ± 5.1%. By using multivariate analyses, we determined that C-reactive protein levels greater than 1.31 mg/dl and the absence of CR were poor prognostic factors. Grade 3 or 4 neutropenia occurred in 35.3% of patients, and febrile neutropenia occurred in only 3 (3.5%) patients.

CONCLUSIONS: RD-RCHOP chemotherapy is well tolerated and effective in elderly patients with DLBCL.

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