Recent research compared the effects of standard chemotherapy dosage with intensified chemotherapy for patients with high-risk diffuse large B-cell lymphoma (DLBCL), published in The Lancet Oncology (published online June 28, 2017; doi:10.1016/S1470-2045(17)30444-8).
Prognoses of younger patients with high-risk DLBCL (age adjusted International Prognostic Index score, 2-3) treated with rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone (R-CHOP) are poor. Limited research exists regarding the variation of standard R-CHOP dosing to treat younger patients with such disease.
Annalisa Chiappella, MD, department of hematology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino (Italy), and colleagues conducted a study to investigate a potential benefit of intensification with high-dose chemotherapy and autologous stem-cell transplantation (ASCT) as a substitute for first-line treatment of younger patients with DLBCL. A total of 399 patients were randomly assigned to receive either of two different R-CHOP dose levels – a full course of rituximab-dose-dense chemotherapy (no transplantation group) or an abbreviated course of rituximab-dose-dense chemotherapy followed by consolidation with rituximab plus high-dose cytarabine plus mitoxantrone (R-MAD) plus dexamethasone and high-dose BEAM chemotherapy (carmustine, etoposide, cytarabine, and melphalan) plus ASCT (transplantation group).
After a median follow-up of 72 months, 2-year failure-free survival was 71% in the transplantation group compared with 62% in the no transplantation group. No significant difference in 5-year overall survival was recorded between these groups (78% vs 77%, respectively).
Grade 3 or worse hematological adverse events were reported in 92% of patients in the transplantation group and 68% of patients in the no transplantation group. Grade 3 or worse non-hematological adverse events were reported in 45% versus 16%, respectively.
While researchers concluded that abbreviated rituximab-dose-dense chemotherapy plus R-MAD plus BEAM and ASCT reduced the risk of treatment failure compared with full course rituximab-dose-dense chemotherapy in younger patients with high-risk DLBCL, the results were not clinically meaningful due to the lack of improvement in overall survival. “These results do not support further consideration of the use of intensification of R-CHOP as an upfront strategy in patients with DLBCL with poor prognosis,” they wrote.—Zachary Bessette
