Concomitant statin use does not impair the clinical outcome of patients with diffuse large B cell lymphoma treated with rituximab-CHOP

Abstract

Preclinical data indicated a detrimental effect of statins on the anti-lymphoma activity of rituximab. We evaluated the impact of concomitant statin medication on the response and survival of patients with diffuse large B cell lymphoma (DLBCL) receiving rituximab-cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) as first-line therapy. Medical histories of patients with DLBCL who were treated with R-CHOP as first-line therapy were assessed for concomitant statin use, response after completion of chemotherapy, event-free survival (EFS), and overall survival (OS). Furthermore, 2-[(18)F]fluor-2-deoxyglucose (FDG)-PET/CT results after completion of first-line therapy were compared between the groups. Overall, 145 patients with DLBCL treated with R-CHOP from January 2001 to December 2009 were analyzed. Twenty-one (15%) patients received statins throughout therapy. Five-year EFS was 67.3% in patients without statins compared with 79% in patients receiving statins during R-CHOP (HR, 0.47; 95% CI, 0.15-1.54, p = 0.2). Five-year OS was 81.4% for patients without statins compared with 93.3% for patients taking statins (HR, 0.58; 95% CI 0.07-4.55, p = 0.6). There were no statistically significant differences in the rates of complete remissions between the two groups (75% in the non-statin group versus 86% in the statin group, p = 0.45). A trend toward a lower rate of complete metabolic responses in FDG-PET/CT after chemotherapy was seen in patients without statin medication compared with the patients taking statins (84% versus 92%, p = 0.068). Concomitant statin use had no adverse impact on response to chemotherapy, EFS, and OS in patients treated with R-CHOP for DLBCL.

HMG-CoA reductase inhibitors as adjuvant treatment for hematologic malignancies: what is the current evidence?

“…Nevertheless, a recent cohort study involving patients with diffuse large B cell lymphoma (DLBCL) treated with CHOP and rituximab (R-CHOP) and concurrent statin use showed a 5-year event-free survival (EFS) of 67.3 % in patients without statin use compared with 79 % of patients receiving statins during R-CHOP (hazard ratio [HR], 0.47; 95 % CI, 0.15-1.54). The overall survival (OS) at 5 years was 81.4 % for patients without statin use compared with 93.3 % in the statin group (HR, 0.58; 95 % CI, 0.07-4.55), thus dismissing any detrimental impact of concurrent statin use during R-CHOP treatment in terms of EFS and OS [96]. Another large prospective cohort study of newly diagnosed patients with DLBCL and follicular lymphoma (FL) found that concomitant use of a statin in rituximabtreated patients had no impact on the overall response rate and survival.…”

Associations between statin use and non‐Hodgkin lymphoma (NHL) risk and survival: a meta‐analysis

“…Concerns have been raised since the publication of an experimental study that demonstrated a possibly impaired effect of rituximab treatment by statin use [18]. Clinical studies [19][20][21][22][23][24]36,57,58], all with a very small number of patients, tried to verify this finding in patients and have produced mixed findings. Our analysis did not show any impact of statin use on NHL progression or survival.…”

Reply to J.R. Carver et al

“…[2][3][4] In this regard, it provides an additional validation of previous studies indicating that concurrent statin use does not affect the clinical efficacy of rituximab and rituximabcontaining therapy. [2][3][4] In this regard, it provides an additional validation of previous studies indicating that concurrent statin use does not affect the clinical efficacy of rituximab and rituximabcontaining therapy.…”