Strategies for improving outcomes with 14-day anthracycline-based regimens in patients with aggressive lymphomas.
Among the strategies developed to improve results in patients with diffuse large B-cell lymphoma, increasing the dose of CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) regimen (dose-intense regimen) and decreasing the duration of cycles (dose-dense regimen) or doing both had been proposed before the rituximab era. With granulocyte colony-stimulating factor support, both regimens are feasible without severe hematologic toxicities. Randomized studies have shown better results than with standard CHOP with longer survivals. However, the addition of rituximab to CHOP (R-CHOP) has also dramatically improved the results without increasing the toxicity. Whether the addition of density or intensity to R-CHOP will continue to improve the results are not known, and preliminary results might challenge this hypothesis. The future benefit for patients with adverse prognostic parameters might not come from dose-dense or dose-intense CHOP-like regimens but from the addition of another drug to R-CHOP.
Broussais-Guillaumot
Florence
F
Department of Hematology, Hospices Civils de Lyon and Université Lyon-I, Lyon, France.
Coiffier
Bertrand
B
D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D010166:Palliative Care; D011241:Prednisone / Q000008:administration & dosage; D000069283:Rituximab; D014750:Vincristine / Q000008:administration & dosage
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone