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Posted by on May 2, 2018 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This study investigated the outcomes of newly diagnosed DLBCL (diffuse large B-cell lymphoma) patients who received prephase treatment before chemotherapy. This study concluded that this treatment before chemotherapy improves symptoms and reduces chemotherapy-related side effects in these patients.

Some background

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), accounting for about 30% of new NHL cases in the U.S. The most widely used treatment for this aggressive cancer is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone).

After the first cycle, treatment-related side effects are a major challenge for many patients. These side effects can lead to hospitalization or even treatment discontinuation. Prephase treatment is very low-dose chemotherapy used to reduce tumor burden and minimize side effects. This helps better prepare patients to receive regular-dose chemotherapy. Whether this type of treatment can improve post-chemotherapy outcomes for patients with newly diagnosed DLBCL remains under investigation.

Methods & findings

This study involved 100 patients with newly diagnosed DLBCL. 63% of patients had stage 3 – 4 disease. 72% of patients had disease limited to the lymph nodes. 50% of patients received vincristine (Oncovin) plus prednisolone (Orapred) prephase treatment before chemotherapy. 50% of patients did not receive prephase treatment before chemotherapy. Chemotherapy was either R-CHOP (35%) or CHOP (65%). 22% of patients also received a G-CSF (granulocyte colony stimulating factor) to boost white blood cell counts. Both groups were followed up for 1 month after the first chemotherapy cycle.

92% of pre-treated patients achieved a performance status of 0 (no symptoms) or 1 (slight symptoms) before the first chemotherapy cycle. After prephase treatment, average serum LDH levels (a measure of tissue damage) decreased from 441.4 to 338.6. This reduction was statistically significant.

At 10 days post-chemotherapy, 26% (prephase) versus 54% (control) of patients reported severe to life-threatening low white blood cell count (neutropenia). Overall, 50% (prephase) versus 86% (control) of patients reported neutropenia of any grade. 16% (prephase) versus 34% (control) of patients reported fever with neutropenia (febrile neutropenia). These differences were statistically significant.

The bottom line

This study concluded that prephase treatment before chemotherapy improves performance status and reduces chemotherapy-related side effects in DLBCL patients.

The fine print

The sample size and follow-up period of this study are quite small. These factors limit the conclusions that may be drawn from these results. Larger, randomized studies with longer follow-up periods are needed to further confirm these results. Whether prephase treatment impacts long-term survival outcomes also warrants investigation.

What’s next?

If you have been recently diagnosed with DLBCL, talk to your care team about the potential benefits of prephase treatment before chemotherapy.

Published By :

European Journal of Haematology

Date :

Mar 22, 2018

Original Title :

Role of prephase treatment prior to definitive chemotherapy in patients with diffuse large B-cell lymphoma.

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