Rituximab-CHOP Versus CHOP Alone or With Maintenance Rituximab in Older Patients With Diffuse Large B-Cell Lymphoma

Abstract

Rituximab administered as induction or maintenance with CHOP chemotherapy significantly prolonged FFS in older DLBCL patients. After R-CHOP, no benefit was provided by MR. These results, which are consistent with an additive effect of rituximab, suggest that future studies could focus on maintenance strategies with novel agents as well as new induction therapies.

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

“…The rate of cardiac toxicity recorded in our study is also among the lowest recorded when compared with results of other trials investigating R-CHOP, or R-CHOP-like regimens, in elderly patients with DLBCL. 18,[30][31][32]44 In our study, multivariate analysis revealed that the need for chemotherapy dose reduction was the only predictive factor of poor outcome, independently of age. Back in the days of first-generation chemotherapeutic regimens, when in a Southwest Oncology group (SWOG) study CHOP chemotherapy was reduced by 50% in patients over 65 years of age, CR rates declined.…”

“…18,30 However, the median age of patients enrolled in the R-CHOP phase III registration trial (GELA study) was only 69 years, and patients aged >80 years were not included in the trial. 18 Other reports showed that nonHodgkin lymphoma patients !70 years are more prone to encounter serious adverse events with R-CHOP than younger patients.…”

Quality of life during maintenance therapy with the anti-CD20 antibody rituximab in patients with B cell non-Hodgkin’s lymphoma: results of a prospective randomized controlled trial

“…Effector mechanisms include complement-mediated cytotoxicity, antibody-dependent cellular cytotoxicity, and possibly direct induction of apoptosis [1,2]. In diffuse large B cell lymphomas (DLBCLs) and follicular lymphomas (FLs), several multicenter prospective randomized trials consistently demonstrated an improved outcome when R was added to chemotherapy [3][4][5][6][7][8][9][10]. In FL and DLBCL, it was attempted to further prolong response duration and survival by administering R during remission as maintenance therapy.…”

“…In FL and DLBCL, it was attempted to further prolong response duration and survival by administering R during remission as maintenance therapy. In DLBCL, Habermann et al [6] performed a study in patients 60 years of age and older who were initially randomized for chemotherapy with cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (CHOP) versus CHOP plus R (R-CHOP). Responding patients underwent a second randomization for R maintenance versus observation only.…”

“…In patients receiving R maintenance, a significant prolongation of the time to treatment failure was observed. This beneficial effect was restricted, however, to patients who had received CHOP alone for initial therapy, while in R-CHOP-treated cases, no differences in response duration were found [6]. Currently, the question whether rituximab maintenance is beneficial in diffuse large B cell lymphoma is examined in another large prospective, international randomized trial [11].…”