Assessing the Efficacy of Full-Dose R-CHOP Therapy on Elderly Patients with Diffuse Large B-Cell Lymphoma

The findings of a study support the use of full-dose R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone+rituximab) therapy in elderly patients under the age of 80 with diffuse large B-cell lymphoma (DLBCL). The study was published in Blood Advances.

In this systematic review, the investigators searched MEDLINE, EMBASE, and Cochrane CENTRAL for studies including over 100 patients treated with R-CHOP/R-CHOP-like therapies published from January 2002 through November 2020. Inclusion criteria included studies that reported the effect of R-CHOP on survival outcomes. Dose intensity (DI) was often calculated as the ratio of the cumulative delivered dose of prespecified drug(s) compared to the cumulative planned dose. Overall, 380 screened records and 13 studies comprised of 5,188 patients were analyzed.

According to the results, lower DI (intended or relative) was associated with inferior survival in almost 80% of studies reporting survival. In a multivariable analysis of 10 studies, six showed an association between DI and other covariates, while four did not.

“Most studies and those larger studies of higher quality showed poorer outcomes associated with reduced DI. In subgroups aged ≥80 years, survival was not consistently affected by reduced DI,” the researchers wrote of the results. They concluded that “DI-specific randomized trials are warranted, but these data support full-dose R-CHOP in elderly and fit patients aged <80 years with DLBCL, but not in those aged ≥80 years, where dose-reduced R-CHOP does not appear to compromise survival.”