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Posted by on Oct 18, 2020 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

This study was carried out to assess the risk of fractures associated with R-CHOP (rituximabcyclophosphamidedoxorubicinvincristine, and prednisolone) for diffuse large B-cell lymphoma (DLBCL). The authors found that there was a high fracture risk in older patients receiving R-CHOP for the treatment of DLBCL. 

Some background

DLBCL is the most common type of lymphoma. It is mostly diagnosed in older people. The most common treatment for DLBCL is R-CHOP. Fractures of the bone are also more common in older people, mostly due to osteoporosis (gradual decrease of bone density). Fractures in elderly populations can significantly decrease their quality of life and even decrease their life expectancy.

Other factors that increase the risk of osteoporosis and fractures include treatment with corticosteroids such as prednisolone. Previous studies have shown that exposure to R-CHOP treatment is likely to increase the risk of having a fracture. Evidence is lacking to define fracture occurrence in patients with DLBCL treated with R-CHOP. 

Methods & findings

There were 729 patients with DLBCL included in this study. All patients were treated with at least 1 cycle of R-CHOP. Patients were followed up for a minimum of 6 months and a maximum of 18 months. The occurrence of bone fractures was evaluated.

81 fractures occurred within the 18-months follow-up. 6.2% of fractures occurred before 6-months, 9.7% before 12 months, and 11.4% before 18 months. 28.2% of fractures occurred after a small impact such as a fall from standing height or less. 

Common fracture sites were the spinal bones (vertebrae). Less common sites included the leg-bones, ribs, and the bones of the forearm and wrist. Half of the fractures were found from the investigation of symptoms and the other half were found accidentally on follow-up imaging. 

The most common risk factors for fractures were known osteoporosis, previous fractures, a diagnosis of rheumatoid arthritis, DLBCL with bone involvement, and pretreatment with steroids.

The bottom line

The authors found an increased fracture risk in elderly patients receiving R-CHOP for the treatment of DLBCL. They suggest more attention to be paid to bone health during treatment with R-CHOP.

The fine print

This study was based on medical records. Information such as vitamin D levels were missing. Also, bone mineral density was not routinely measured. 

What’s next?

If you have concerns regarding bone health, please discuss this with your doctor.

Published By :

Blood advances

Date :

Sep 22, 2020

Original Title :

Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma.

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