Age and performance status are predictive factors of failure to complete rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) treatment among patients with diffuse large B-cell lymphoma (DLBCL), according to research published in the American Journal of Hematology.1
Anthracycline-based chemotherapy regimens are standard of care for patients with DLBCL, with some studies suggesting that as few as 4 rounds of R-CHOP may be sufficient for achieving a cure in low-risk patients. There is, however, clinical and real-world evidence that indicates some patients do not complete treatment for reasons other than lack of response, which, where reported, appears to occur in only 1% to 3% of those who discontinue R-CHOP.
For this study, researchers reviewed data from 3149 patients with DLBCL, of which patients completed either at least 6 cycles of R-CHOP or 3 rounds of R-CHOP plus radiotherapy in the case of stage I disease, to characterize reasons for treatment discontinuation other than lack of response and to enumerate outcomes among these patients.
In the overall cohort, the median age was 69 (range, 18-94), 1770 patients (56%) were male, nearly half (1539; 49%) had a performance status of 0, and 1781 patients (56%) had elevated lactate dehydrogenase (LDH) levels. Eighty-four percent of patients completed treatment.
Among patients who did not complete treatment, 10% of the overall cohort discontinued R-CHOP for a reason other than non-response; among them, 147 patients (5%) received 1-3 R-CHOP cycles and 168 patients (5%) received 4-5 cycles.
Patients who did not complete treatment had, overall, worse outcomes, with 5-year overall survival (OS) rates of 26%, 49%, and 76% for 1-3 cycles, 4-5 cycles, and treatment completion, respectively.
Being older than 75 years and having poor performance status, extranodal disease, and a Charlson Comorbidity Index of 1 or greater were each linked with non-response treatment discontinuation on multivariate analysis.
“These findings indicate a need for improved treatment tailoring with for example pre-planned dose reductions and/or novel more tolerable therapeutic options, for patients with certain base-line characteristic,” the authors wrote. “To better ascertain which clinical and biological characteristics this may be, further studies are needed.”
Wästerlid T, Harrysson S, Andersson TM, et al. Outcome and determinants of failure to complete primary R-CHOP treatment for reasons other than non-response among patients with diffuse large B-cell lymphoma [published online March 17, 2020]. Am J Hematol. doi: 10.1002/ajh.25789