In a nutshell
This study compared two chemotherapy regimens, CHOP14 and CHOP21, combined with rituximab (Rituxan) in patients with newly diagnosed diffuse large B-cell lymphoma. This study concluded that there were no significant differences in survival between the two regimens.
Some background
Diffuse large B-cell lymphoma (DLBCL) is a commonly diagnosed type of non-Hodgkin lymphoma. The standard treatment for DLBCL has been the CHOP chemotherapy combination (cyclophosphamide, doxorubicin, vincristine, and prednisolone). One previous study showed improved survival with six cycles of CHOP every 14 days (CHOP14) compared to every 21 days (CHOP21). However, other studies have not found a survival benefit.
Rituximab is a monoclonal antibody. This treatment binds to the CD20 protein on cancer cells, leading to cancer cell death. Rituximab combined with CHOP21 (R-CHOP21) has been shown to improve cure rates in DLBCL. It has also been shown to improve outcomes when combined with CHOP14 (R-CHOP14) in certain populations. It is not clear whether R-CHOP14 leads to better survival outcomes compared to R-CHOP21.
Methods & findings
This study included 1080 patients who were randomly assigned to treatment with R-CHOP14 (540 patients) or R-CHOP21 (540 patients). 91% of patients in each group completed at least 6 cycles (of 8 planned). Patients were followed for an average of 46 months.
Two-year progression-free survival (time from treatment until disease progression) was 74.8% with R-CHOP21 and 75.4% with R-CHOP14. Eight patients treated with R-CHOP21 and six treated with R-CHOP14 experienced relapse in the central nervous system.
Two-year overall survival (time from treatment until death from any cause) was 80.8% with R-CHOP21 and 82.7% with R-CHOP14. There were no factors or patient characteristics that predicted a survival benefit for R-CHOP14 versus R-CHOP21.
Rates of severely low white blood cell levels with or without fever occurred more often with R-CHOP21 (60%) compared to R-CHOP14 (31%). R-CHOP21 patients, however, were less likely to receive treatments to prevent this effect. Other side effects included low platelet levels (blood cells involved in clotting) and infection.
The bottom line
This study concluded that R-CHOP14 did not improve survival over R-CHOP21. The authors suggested that R-CHOP21 should remain the standard treatment.
Published By :
Lancet (London, England)
Date :
May 25, 2013
