In a nutshell
This study investigated whether the omission of vincristine (Oncovin) from the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) regimen affects survival in patients with diffuse large B-cell lymphoma (DLBCL). This study concluded that omitting vincristine does not affect survival in these patients.
The current standard of care for DLBCL is R-CHOP chemotherapy. High-dose R-CHOP has been associated with improved survival. However, some of the agents in this regimen are associated with side effects. These side effects can lead to reduced doses of treatment.
Vincristine has been associated with side effects that affect the nervous system. The only options for managing these effects is dose reduction or omission. Whether omitting vincristine from R-CHOP impacts survival in patients with DLBCL remains under investigation.
Methods & findings
This study included the records of 541 patients with DLBCL or high-grade B-cell lymphoma. 65.2% of patients had advanced (stage 3 – 4) disease. 82.4% of all patients received full-dose vincristine in R-CHOP treatment. All other patients received R-CHOP without vincristine.
Vincristine was omitted from R-CHOP in 17.6% of patients due to side effects. This was decided during the last 3 cycles of treatment in 90.5% of these patients. These patients were older and had higher-risk disease compared to patients who received all doses of vincristine.
The omission of vincristine had no impact on overall survival (OS; patients still alive at the end of follow-up) or disease-free survival (DFS; patients still alive without signs or symptoms of cancer).
Certain factors were associated with increased risk of a poorer OS. These included being 60 years or older (1.94-fold), having bulky disease (1.58-fold; tumors larger than 5 centimeters), and having disease in the kidneys (2.45-fold). Having advanced disease was significantly associated with a lower DFS (2.04-fold).
The bottom line
This study concluded that omitting vincristine does not affect survival in patients with DLBCL treated with R-CHOP. The authors suggest that vincristine can be safely omitted in case of severe side effects.
The fine print
This study was retrospective, meaning it looked back in time to analyze data. Only 17.6% of patients in this study had omitted vincristine, which is a small population.
This study only included Swedish patients, so the results may not be applicable to all patients.
Published By :
Annals of Hematology
Aug 08, 2018
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