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Impact of Omission/Reduction of Vincristine From R-CHOP in Treatment of DLBCL
Shoko Marshall1, Noriko Nishimura2, Norihito Inoue3
1Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan; Department of Hematology Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Toyo, Japan.
Background:
The R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is the standard therapy for patients with diffuse large B-cell lymphoma (DLBCL). However, vincristine is sometimes omitted or reduced owing to side effects.
Materials And Methods:
We retrospectively reviewed newly diagnosed patients with DLBCL with R-CHOP-like chemotherapy in our institute from January 2005 to February 2018 to investigate whether the omission/reduction of vincristine reduced the efficacy of the treatment. We compared the overall survival (OS) with and without the omission/reduction of vincristine from the R-CHOP regimen.
Results:
A total of 576 cases were reviewed, and vincristine was omitted/reduced in 50 (9%) patients. The 4-year OS with and without vincristine omission/reduction for relative dose intensity < 80%, 50%, and 25% was 70% versus 82% (P = .035), 70% versus 82% (P = .085), and 53% versus 82% (P = .0007). In a multivariate analysis, adjusting for international prognostic index risk factors, a statistically significant, poor OS was indicated in the patients with relative dose intensity < 25%.
Conclusions:
Excessive dose omission/reduction of vincristine might lead to a substantial loss of efficacy of R-CHOP therapy.
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