Rituximab in combination with CHOP improves survival in elderly patients with aggressive non-Hodgkin's lymphoma

Diffuse large B-cell lymphoma (DLCL) is the most frequently diagnosed subtype of non-Hodgkin's lymphoma (NHL), and more than 50% of cases present in patients over 60 years of age. Although cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP) is currently regarded as the gold standard treatment for DLCL, less than half of the elderly patients treated are cured. Therefore, it is essential that new strategies are developed. Rituximab is a chimeric monoclonal antibody that is directed against the B-cell-specific antigen CD20 that is expressed on 80% of NHLs. Pilot trials combining rituximab with CHOP have suggested an efficacy advantage in both indolent and aggressive B-cell NHL, with no significant impact on toxicity. The Groupe d'Etude des Lyphomes de l'Adulte LNH-98.5 trial is the first randomized clinical trial to compare rituximab plus CHOP with CHOP alone in lymphoma patients. The trial compared the two treatment regimens in elderly patients with aggressive DLCL. Interim data (18-month follow-up) from this trial showed that the addition of rituximab to CHOP results in a statistically superior benefit in survival compared with CHOP alone. These groundbreaking data are the first in 20 years to show statistical improvement over CHOP and this suggests that rituximab plus CHOP may become the new gold standard treatment for elderly patients with DLCL.