Addition of rituximab to reduced-dose CHOP chemotherapy is feasible for elderly patients with diffuse large B-cell lymphoma.
OBJECTIVE
The aim of this study was to evaluate the efficacy and toxicity of reduced-dose (RD) RCHOP (rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy for elderly patients with diffuse large B-cell lymphoma (DLBCL).


METHODS
This study comprised 85 patients, aged ≥ 60 years, who were diagnosed with DLBCL; patients were enrolled at a single center between June 2004 and December 2009. Patients received either 6 or 8 cycles of RD-RCHOP, spaced 3 weeks apart, at the physician's discretion. The RD-RCHOP regimen consisted of 375 mg/m(2) rituximab, 600 mg/m(2) cyclophosphamide, 30 mg/m(2) doxorubicin, and 1-mg vincristine on day 1 of each cycle, and 40-mg prednisone on days 1-5. The patients received granulocyte colony-stimulating factor if they experienced grade 4 neutropenia or febrile neutropenia during any cycle.


RESULTS
The average relative dose intensity was 97.3% for doxorubicin and 97.4% for cyclophosphamide. The complete remission (CR) and overall response rate were 67.1 and 89.5%, respectively. The 3-year event-free survival and overall survival rates were 71.9% ± 5.1% and 83.3% ± 5.1%. By using multivariate analyses, we determined that C-reactive protein levels greater than 1.31 mg/dl and the absence of CR were poor prognostic factors. Grade 3 or 4 neutropenia occurred in 35.3% of patients, and febrile neutropenia occurred in only 3 (3.5%) patients.


CONCLUSIONS
RD-RCHOP chemotherapy is well tolerated and effective in elderly patients with DLBCL.
Division of Hematology-Oncology, Department of Internal Medicine, School of Medicine, Medical Research Institute, Pusan National University Hospital, 1-10, Ami-Dong, Seo-Gu, Busan, Korea.
Ho-Jin
HJ
Shin
Joo Seop
JS
Chung
Moo-Kon
MK
Song
Seon-Kyeong
SK
Kim
Sangmin
S
Choe
Goon-Jae
GJ
Cho
D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D000069283:Rituximab; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D058846:Antibodies, Monoclonal, Murine-Derived; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D011239:Prednisolone