Evaluating different doxorubicin doses for patients with diffuse large B-cell lymphoma

This study evaluated three different chemotherapy regimens with varying doses of doxorubicin (Adriamycin) for patients with diffuse large B-cell lymphoma (DLBCL). This study concluded that R-CEOP70 could be safely used instead of R-CHOP50, while R-CEOP90 may be recommended for younger patients.

DLBCL is one of the most common subtypes of non-Hodgkin's lymphoma. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy has remained the standard of care for newly diagnosed patients. However, about 30 – 40% of all patients have the cancer come back after initial treatment. These patients need other treatment options.

One option is to increase the dose of one or more chemotherapy drugs. Previous studies have shown that increasing the dose of doxorubicin (Adriamycin) can improve outcomes for patients with acute leukemia. However, doxorubicin is associated with side effects on the heart. R-CEOP70 and R-CEOP90 replace doxorubicin with another chemotherapy drug called epirubicin (Ellence). Whether these regimens are as effective as R-CHOP for patients with DLBCL is unclear.

This study had 648 patients with newly diagnosed DLBCL. Patients were divided into two age groups: over age 60 (38%) and age 60 or younger (62%). Patients over age 60 received either standard R-CHOP (R-CHOP50) or R-CEOP70 chemotherapy. Patients age 60 or younger also received either these regimens or R-CEOP90. Patients were followed-up for an average of 45.7 months.

Two years later, 72.5% of all patients treated with R-CHOP50 did not have tumor growth or spread. For patients treated with R-CEOP70, this rate was 72.4%. Similarly, 86.2% (R-CHOP50) versus 85.8% (R-CEOP70) of patients were still alive two years later.

Significantly more of the younger patients treated with R-CEOP90 were still alive two years later without tumor growth or spread compared to those treated with R-CHOP50 (88.8% vs. 75.9%). 77.4% of younger patients treated with R-CEOP70 were still alive two years later without tumor growth or spread.

Low white blood cell count and infections were the most common serious side effects. Among younger patients, seriously low white blood cell count was the most common in the R-CEOP90 group compared to R-CEOP70 (72% vs. 63%). Serious infections were also the most common with R-CEOP90 treatment (11% vs. 7%).

Poorer heart pumping is one long-term side effect of chemotherapy treatment. Three years later, significantly fewer of the older patients treated with R-CEOP70 had poorer heart pumping compared to the R-CHOP50 group (13% vs. 29%). Significantly fewer of the younger patients treated with R-CEOP90 also had poorer heart pumping compared to the R-CHOP50 group (11% vs. 26%).

This study concluded that R-CEOP70 is just as effective as standard R-CHOP, but with fewer side effects to the heart. The authors suggest that R-CEOP90 may have the most benefit for patients younger than 60.

This study was not a blind study, which means that both the researchers and the patients knew which chemotherapy regimens were given. This may bias the results. Also, all the patients in this study were Chinese, so these results may not apply to all patients. More studies are needed to confirm these results.

Talk to your care team about the potential benefits of adding epirubicin to your treatment regimen.