The Relative Dose Intensity Changes during Cycles of Standard Regimens in Patients with Diffuse Large B-Cell Lymphoma

Area of Science:

• Oncology
• Hematology
• Clinical Pharmacology

Background:

• Diffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin lymphoma.
• First-line chemotherapy regimens are standard but optimal dose intensity requires further investigation.
• Average Relative Dose Intensity (ARDI) is a measure of chemotherapy delivery, but its longitudinal impact is understudied in DLBCL.

Purpose of the Study:

• To investigate the trajectory of ARDI during first-line chemotherapy in DLBCL patients.
• To evaluate the association between ARDI patterns and overall survival (OS).
• To identify predictors of unfavorable ARDI changes.

Main Methods:

• Multi-center, longitudinal, observational retrospective study.
• Analysis of 307 patients receiving first-line chemotherapy for DLBCL.
• Multivariate Cox hazards modeling and group-based trajectory modeling were used.

Main Results:

• Higher ARDI up to cycle 6 was associated with prognostic benefits.
• Two patient groups with ARDI falling below 50% by cycles 4-6 showed significantly poorer prognosis (p=0.02).
• Geriatric Nutritional Risk Index predicted unfavorable ARDI changes (OR 2.540, p=0.044).

Conclusions:

• Maintaining ARDI, especially in early cycles up to cycle 6, is vital for DLBCL patient prognosis.
• Significant ARDI reduction by mid-treatment is linked to worse outcomes.
• Malnutrition is a significant factor associated with unfavorable ARDI trajectories and prognosis.