title: CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma.
abstract: BACKGROUND
  The standard treatment for patients with diffuse large-B-cell lymphoma is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Rituximab, a chimeric monoclonal antibody against the CD20 B-cell antigen, has therapeutic activity in diffuse large-B-cell lymphoma. We conducted a randomized trial to compare CHOP chemotherapy plus rituximab with CHOP alone in elderly patients with diffuse large-B-cell lymphoma.
  
  
  METHODS
  Previously untreated patients with diffuse large-B-cell lymphoma, 60 to 80 years old, were randomly assigned to receive either eight cycles of CHOP every three weeks (197 patients) or eight cycles of CHOP plus rituximab given on day 1 of each cycle (202 patients).
  
  
  RESULTS
  The rate of complete response was significantly higher in the group that received CHOP plus rituximab than in the group that received CHOP alone (76 percent vs. 63 percent, P=0.005). With a median follow-up of two years, event-free and overall survival times were significantly higher in the CHOP-plus-rituximab group (P<0.001 and P=0.007, respectively). The addition of rituximab to standard CHOP chemotherapy significantly reduced the risk of treatment failure and death (risk ratios, 0.58 [95 percent confidence interval, 0.44 to 0.77] and 0.64 [0.45 to 0.89], respectively). Clinically relevant toxicity was not significantly greater with CHOP plus rituximab.
  
  
  CONCLUSIONS
  The addition of rituximab to the CHOP regimen increases the complete-response rate and prolongs event-free and overall survival in elderly patients with diffuse large-B-cell lymphoma, without a clinically significant increase in toxicity.
authors.affiliation: Hospices Civils de Lyon and the Université Claude Bernard, Lyons, France. bertrand.coiffier@chu-lyon.fr
authors.forename: Bertrand
authors.initials: B
authors.lastname: Coiffier
authors.forename: Eric
authors.initials: E
authors.lastname: Lepage
authors.forename: Josette
authors.initials: J
authors.lastname: Briere
authors.forename: Raoul
authors.initials: R
authors.lastname: Herbrecht
authors.forename: Hervé
authors.initials: H
authors.lastname: Tilly
authors.forename: Reda
authors.initials: R
authors.lastname: Bouabdallah
authors.forename: Pierre
authors.initials: P
authors.lastname: Morel
authors.forename: Eric
authors.initials: E
authors.lastname: Van Den Neste
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaulard
authors.forename: Felix
authors.initials: F
authors.lastname: Reyes
authors.forename: Pierre
authors.initials: P
authors.lastname: Lederlin
authors.forename: Christian
authors.initials: C
authors.lastname: Gisselbrecht
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D000069283:Rituximab; D016019:Survival Analysis; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone