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Impact of Vincristine Dose Reduction on Outcomes of Patients With Advanced-Stage Diffuse Large B-Cell Lymphoma
Jantina P Kortleve1,2, Sofie Engels1,3, Berber A Zweers4
1Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Introduction:
Vincristine dose reduction during R-CHOP treatment of diffuse large B-cell lymphoma (DLBCL) is frequently required due to vincristine-induced polyneuropathy (VIPN). Previous studies suggested an association between vincristine relative dose intensity and inferior outcomes. However, it remains unclear whether this applies to selective vincristine dose reduction or is mainly related to combined reductions of other chemotherapeutic agents.
Methods:
We retrospectively evaluated treatment outcomes of patients newly diagnosed with advanced-stage DLBCL treated with R-CHOP between 2015 and 2021. Patients were categorized as receiving full-dose R-CHOP, selective vincristine dose reduction, or combined reductions of R-CHOP components.
Results:
Among 196 included patients, the 5-year overall survival (OS) was 84% in patients with a selective vincristine dose reduction and 79% in patients receiving full-dose. In multivariable analyses, selective vincristine dose reduction was not associated with inferior progression-free survival or OS. In contrast, lower cumulative doxorubicin dose was associated with inferior treatment outcomes.
Conclusions:
Selective vincristine dose reduction due to VIPN was not associated with inferior progression-free or OS in patients with DLBCL treated with R-CHOP. These findings support vincristine dose reduction for management of VIPN while maintaining adequate doxorubicin dose intensity.
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