Is R-CVP safer and more effective than R-CHOP for patients with painless NHL?

This study evaluated the safety and effectiveness of two different chemotherapy regimens for patients with indolent (painless) non-Hodgkin’s lymphoma (NHL). This study found that the R-CVP regimen was similarly effective and had fewer side effects compared to R-CHOP for these patients.

Chemoimmunotherapy is the typical first-line treatment for patients with NHL. R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) is the most commonly used regimen. This regimen is very effective in 50 to 60% of patients. However, doxorubicin is associated with heart-related side effects, even at low doses.

R-CVP is another treatment option. This regimen is like R-CHOP but omits doxorubicin to minimize side effects. Whether R-CVP is more effective for patients with indolent NHL is unclear.

This study had 250 patients with NHL. Almost half (42%) of all patients had follicular lymphoma. 127 patients received R-CHOP. 123 patients received R-CVP. All patients were then treated with rituximab maintenance therapy (treatment meant to keep the cancer from coming back). Patients were followed for an average of 66 to 70 months.

Overall, 97.1% (R-CHOP) and 94.5% (R-CVP) of patients responded to treatment. Slightly more patients in the R-CHOP group had no signs of cancer compared to the R-CVP group (43.6% vs. 36.3%).

At follow-up, slightly more patients in the R-CVP group were still alive 5 years later compared to the R-CHOP group (84% vs. 89%). Slightly more patients in the R-CHOP group did not have tumor growth or spread 5 years later compared to the R-CVP group (71% vs. 69%).  

296 patients in the R-CHOP group had side effects compared to 178 patients in the R-CVP group. A low white blood cell level was the most reported side effect (17.0% vs. 10.3%). Significantly more patients in the R-CHOP group also had serious side effects compared to the R-CVP group (33.1% vs. 15.3%). The most common ones were seriously low white blood cell levels (11.6% vs. 3.4%) and serious infection (10.7% vs. 2.5%).

This study concluded that the R-CVP regimen was similarly effective and had fewer side effects compared to R-CHOP for patients with indolent NHL. The authors suggest that R-CVP may be a better choice for first-line treatment due to fewer side effects.

More patients in the R-CHOP group had advanced-stage disease compared to the R-CVP group. This may bias the results.