title: Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14.
abstract: DLBCL is an aggressive lymphoma treated with R-CHOP. Recently, attempts have been made to improve the outcome by increasing both dose-density and intensity but there have been no benefits in terms of survival. When treating malignancies RDI is important to consider but there is little published information on DLBCL. The purpose of this study was to analyze the differential prognostic impact of RDI in two cohorts of DLBCL patients treated with R-CHOP21 or R-CHOP14. From January 2001 to August 2013 we included DLBCL patients homogenously treated with R-CHOP21 or R-CHOP14, with or without radiotherapy, at University Hospital Son Espases, Hospital Son Llatzer of Palma and Hospital del Mar of Barcelona (N = 157). In order to avoid selection bias the patients were retrospectively identified from the Pathology Department and Pharmacy registries. Median follow-up was 68 months. There was no difference in the response or survival between the two cohorts. In the R-CHOP21 group, both a reduction higher than 15% in RDI (RR 7.41) and R-IPI (RR 2.99) were independently associated with OS. However, a reduction higher than 15% in RDI (RR 4.41) was only noted for PFS. In the R-CHOP14 group, NCCN-IPI (RR 7.09) and B-symptoms (RR 5.37) for OS; AA stage III-IV (RR 6.26) and bulky disease (RR 4.05) for PFS. There was a trend towards a higher rate of RDI reduction observed in the R-CHOP14 group but it only made an impact in the R-CHOP21 group. We conclude that R-CHOP21 and R-CHOP14 are equivalent regimens in terms of response and survival, but only if RDI reductions are avoided. For patients receiving R-CHOP21 we recommend using clinical and support measures in order to avoid RDI reductions.
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Leyre
authors.initials: L
authors.lastname: Bento
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Antonia Maria
authors.initials: AM
authors.lastname: Bautista-Gili
authors.affiliation: Hematology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Garcia
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Martinez-Serra
authors.affiliation: Hematology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Sanchez
authors.affiliation: Pharmacy Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Martorell
authors.affiliation: Pharmacy Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Gines
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Lucia
authors.initials: L
authors.lastname: Garcia
authors.affiliation: Hematology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Gimeno
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Mariana
authors.initials: M
authors.lastname: Ferraro
authors.affiliation: Hematology Department, Son Llatzer Hospital, Palma, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Del Campo
authors.affiliation: Hematology Department, Son Llatzer Hospital, Palma, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Bargay
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Perez
authors.affiliation: Hematology Department, Can Misses Hospital, Ibiza, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Vercher
authors.affiliation: Hematology Department, Hospital of Manacor, Manacor, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Scaff
authors.affiliation: Hematology Department, Mateu Orfila Hospital, Mahon, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Pacheco
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ballester
authors.affiliation: Oncology Department, University Hospital Son Espases, Palma, Spain.
authors.forename: Florencia
authors.initials: F
authors.lastname: Garcia
authors.affiliation: Pathology Department, University Hospital Son Espases, Palma, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Hematology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salar
authors.affiliation: Hematology Department, Son Espases University Hospital, Palma, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Besalduch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone