R-CHOP is associated with an increased risk of fractures in older patients with aggressive B-cell non-Hodgkin lymphoma.

This study investigated the occurrence of fractures and identified factors associated with a higher risk of fractures in patients with aggressive non-Hodgkin lymphoma (NHL) who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone)-like therapy. The data showed that there is a higher risk of developing new fractures in older patients with existing fractures.

Non-Hodgkin lymphoma (NHL) is a cancer that starts in white blood cells called lymphocytes. These are part of the body’s immune system. It is mostly diagnosed in older people. The most common treatment for aggressive NHL involves the chemotherapy regimen called R-CHOP. In older patients, R-CHOP therapy increases the risk of developing osteoporosis (gradual decrease of bone density) and the risk of having a fracture.

Fractures in older people can significantly decrease their quality of life and even decrease their life expectancy. However, the factors associated with a higher risk of fractures in patients with NHL who received R-CHOP-like therapy are not well characterized.

This study involved 162 patients with aggressive NHL. All patients received R-CHOP-like chemotherapy regimens and underwent a CT scan before and after treatment. The average age of the patient at diagnosis was 60 years.

38 (23%) patients had previous fractures (spine, rib, or pelvic) before receiving chemotherapy. After 1 year of R-CHOP treatment, 16 (10%) patients developed new fractures. 12 of the patients who developed new fractures already had a fracture before.

Patients who had a previous fracture were 10.45 times more likely to develop a new fracture during R-CHOP treatment than those who did not have a fracture before.

This study concluded that older patients with aggressive NHL who received R-CHOP-like therapy should be evaluated for existing fractures before treatment. The authors suggested that those with existing fractures should be considered for bone-directed therapy to decrease the risk of new fractures.

This study looked back in time at medical records. A non-cancer or a non-chemotherapy control group was missing.