VARIATION IN R-CHOP REGIMENS FOR PATIENTS WITH STAGE II-IV DIFFUSE LARGE B-CELL LYMPHOMA IN THE NETHERLANDS
(Abstract release date: 05/19/16)
EHA Library. Brink M. 06/09/16; 134616; PB1716
Dr. Mirian Brink
Contributions
Contributions
Abstract
Abstract: PB1716
Type: Publication Only
Background
The 2014 Dutch national clinical practice guideline for diffuse large B-cell lymphoma (DLBCL) recommends 8x R-CHOP21 or 6x R-CHOP14 followed by 2 additional cycles of rituximab (2R) as first line therapy for stage II-IV DLBCL patients with an age-adjusted International Prognostic Index (aaIPI) of 1-3. However, international guidelines tend to promote 6x R-CHOP21 as the preferred first line treatment.
Aims
The aim of this population-based study was to evaluate which treatment regimens were applied in the Netherlands.
Methods
We selected 840 patients diagnosed in 2014 with stage II-IV DLBCL and aaIPI 1-3 (median [range] age 69 years [18-99]; 55% male) from the nationwide population-based Netherlands Cancer Registry. All patients were treated outside clinical trials. In this study, first line treatment was defined as 6x or 8x R-CHOP14/21, and, in case of 6x R-CHOP14/21, with or without 2R. Overall response rate (ORR) was defined as achieving complete or partial response, i.e. CR(u) or PR. Data were analyzed for the total cohort, as well as stratified by age and treatment regimen.
Results
Treatment with R-CHOP14/21 was initiated in 651 (78%) patients, while 103 (12%) patients received other (chemo)therapeutic regimens. The remaining 86 (10%) patients received no therapy. Of those who received R-CHOP14/21, 508 (78%) completed 6x or 8x, 122 (19%) received less than 6x, and 21 (3%) received 7x.Of the patients who completed treatment (6x +/- 2R or 8x), 6x R-CHOP21, 6x R-CHOP21+2R and 8x R-CHOP21 regimens were provided in 21%, 20% and 45% of patients, while 6x R-CHOP14, 6x R-CHOP14+2R and 8x R-CHOP14 in 3%, 3% and 8% of patients, respectively. Of note, 8x R-CHOP14/21 was most commonly applied (53%; N=269).Patients aged <65 years (N=233) more often received 8x (82%), whereas patients aged ≥65 years more often received 6x (72%).As for patients aged 65-74 years (N=160), 39 (24%) patients received 6x R-CHOP21, 49 (31%) 6x R-CHOP21+2R and 55 (34%) 8x R-CHOP21. Only 17 (11%) patients received 6x R-CHOP14 +/- 2R or 8x R-CHOP14.For patients aged ≥75 years (N=115), all but one received R-CHOP21 regimens, of which 43% received 6x, 39% 6x with 2R and 17% 8x.The ORR was 88% (448/508) for patients who completed treatment. Further, the ORR was 87% for 8x R-CHOP21, 83% for 6x R-CHOP21 and 94% for 6x R-CHOP14+2R and this was irrespective of age group.
Conclusion
Our results show that treatment with R-CHOP was initiated in 78% of patients with stage II-IV DLBCL and an aaIPI of 1-3. Three-weekly regimens were applied to 85% of patients who completed treatment. Although based on modest patient numbers, the ORR for 6x R-CHOP21, which is the internationally preferred R-CHOP regimen, was 83%. That value compares somewhat lower to the ORRs in the 8x R-CHOP21 and 6x R-CHOP14+2R groups, i.e. 87% and 94%, respectively. Collectively, these population-based analyses demonstrate that there is variation in the provision of R-CHOP regimens in daily practice, which could be related to the ongoing debate among clinicians in the Netherlands whether 6x or 8x R-CHOP21 should be the standard of care as first line therapy for stage II-IV DLBCL patients with an aaIPI of 1-3.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Treatment
Type: Publication Only
Background
The 2014 Dutch national clinical practice guideline for diffuse large B-cell lymphoma (DLBCL) recommends 8x R-CHOP21 or 6x R-CHOP14 followed by 2 additional cycles of rituximab (2R) as first line therapy for stage II-IV DLBCL patients with an age-adjusted International Prognostic Index (aaIPI) of 1-3. However, international guidelines tend to promote 6x R-CHOP21 as the preferred first line treatment.
Aims
The aim of this population-based study was to evaluate which treatment regimens were applied in the Netherlands.
Methods
We selected 840 patients diagnosed in 2014 with stage II-IV DLBCL and aaIPI 1-3 (median [range] age 69 years [18-99]; 55% male) from the nationwide population-based Netherlands Cancer Registry. All patients were treated outside clinical trials. In this study, first line treatment was defined as 6x or 8x R-CHOP14/21, and, in case of 6x R-CHOP14/21, with or without 2R. Overall response rate (ORR) was defined as achieving complete or partial response, i.e. CR(u) or PR. Data were analyzed for the total cohort, as well as stratified by age and treatment regimen.
Results
Treatment with R-CHOP14/21 was initiated in 651 (78%) patients, while 103 (12%) patients received other (chemo)therapeutic regimens. The remaining 86 (10%) patients received no therapy. Of those who received R-CHOP14/21, 508 (78%) completed 6x or 8x, 122 (19%) received less than 6x, and 21 (3%) received 7x.Of the patients who completed treatment (6x +/- 2R or 8x), 6x R-CHOP21, 6x R-CHOP21+2R and 8x R-CHOP21 regimens were provided in 21%, 20% and 45% of patients, while 6x R-CHOP14, 6x R-CHOP14+2R and 8x R-CHOP14 in 3%, 3% and 8% of patients, respectively. Of note, 8x R-CHOP14/21 was most commonly applied (53%; N=269).Patients aged <65 years (N=233) more often received 8x (82%), whereas patients aged ≥65 years more often received 6x (72%).As for patients aged 65-74 years (N=160), 39 (24%) patients received 6x R-CHOP21, 49 (31%) 6x R-CHOP21+2R and 55 (34%) 8x R-CHOP21. Only 17 (11%) patients received 6x R-CHOP14 +/- 2R or 8x R-CHOP14.For patients aged ≥75 years (N=115), all but one received R-CHOP21 regimens, of which 43% received 6x, 39% 6x with 2R and 17% 8x.The ORR was 88% (448/508) for patients who completed treatment. Further, the ORR was 87% for 8x R-CHOP21, 83% for 6x R-CHOP21 and 94% for 6x R-CHOP14+2R and this was irrespective of age group.
Conclusion
Our results show that treatment with R-CHOP was initiated in 78% of patients with stage II-IV DLBCL and an aaIPI of 1-3. Three-weekly regimens were applied to 85% of patients who completed treatment. Although based on modest patient numbers, the ORR for 6x R-CHOP21, which is the internationally preferred R-CHOP regimen, was 83%. That value compares somewhat lower to the ORRs in the 8x R-CHOP21 and 6x R-CHOP14+2R groups, i.e. 87% and 94%, respectively. Collectively, these population-based analyses demonstrate that there is variation in the provision of R-CHOP regimens in daily practice, which could be related to the ongoing debate among clinicians in the Netherlands whether 6x or 8x R-CHOP21 should be the standard of care as first line therapy for stage II-IV DLBCL patients with an aaIPI of 1-3.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Treatment
Abstract: PB1716
Type: Publication Only
Background
The 2014 Dutch national clinical practice guideline for diffuse large B-cell lymphoma (DLBCL) recommends 8x R-CHOP21 or 6x R-CHOP14 followed by 2 additional cycles of rituximab (2R) as first line therapy for stage II-IV DLBCL patients with an age-adjusted International Prognostic Index (aaIPI) of 1-3. However, international guidelines tend to promote 6x R-CHOP21 as the preferred first line treatment.
Aims
The aim of this population-based study was to evaluate which treatment regimens were applied in the Netherlands.
Methods
We selected 840 patients diagnosed in 2014 with stage II-IV DLBCL and aaIPI 1-3 (median [range] age 69 years [18-99]; 55% male) from the nationwide population-based Netherlands Cancer Registry. All patients were treated outside clinical trials. In this study, first line treatment was defined as 6x or 8x R-CHOP14/21, and, in case of 6x R-CHOP14/21, with or without 2R. Overall response rate (ORR) was defined as achieving complete or partial response, i.e. CR(u) or PR. Data were analyzed for the total cohort, as well as stratified by age and treatment regimen.
Results
Treatment with R-CHOP14/21 was initiated in 651 (78%) patients, while 103 (12%) patients received other (chemo)therapeutic regimens. The remaining 86 (10%) patients received no therapy. Of those who received R-CHOP14/21, 508 (78%) completed 6x or 8x, 122 (19%) received less than 6x, and 21 (3%) received 7x.Of the patients who completed treatment (6x +/- 2R or 8x), 6x R-CHOP21, 6x R-CHOP21+2R and 8x R-CHOP21 regimens were provided in 21%, 20% and 45% of patients, while 6x R-CHOP14, 6x R-CHOP14+2R and 8x R-CHOP14 in 3%, 3% and 8% of patients, respectively. Of note, 8x R-CHOP14/21 was most commonly applied (53%; N=269).Patients aged <65 years (N=233) more often received 8x (82%), whereas patients aged ≥65 years more often received 6x (72%).As for patients aged 65-74 years (N=160), 39 (24%) patients received 6x R-CHOP21, 49 (31%) 6x R-CHOP21+2R and 55 (34%) 8x R-CHOP21. Only 17 (11%) patients received 6x R-CHOP14 +/- 2R or 8x R-CHOP14.For patients aged ≥75 years (N=115), all but one received R-CHOP21 regimens, of which 43% received 6x, 39% 6x with 2R and 17% 8x.The ORR was 88% (448/508) for patients who completed treatment. Further, the ORR was 87% for 8x R-CHOP21, 83% for 6x R-CHOP21 and 94% for 6x R-CHOP14+2R and this was irrespective of age group.
Conclusion
Our results show that treatment with R-CHOP was initiated in 78% of patients with stage II-IV DLBCL and an aaIPI of 1-3. Three-weekly regimens were applied to 85% of patients who completed treatment. Although based on modest patient numbers, the ORR for 6x R-CHOP21, which is the internationally preferred R-CHOP regimen, was 83%. That value compares somewhat lower to the ORRs in the 8x R-CHOP21 and 6x R-CHOP14+2R groups, i.e. 87% and 94%, respectively. Collectively, these population-based analyses demonstrate that there is variation in the provision of R-CHOP regimens in daily practice, which could be related to the ongoing debate among clinicians in the Netherlands whether 6x or 8x R-CHOP21 should be the standard of care as first line therapy for stage II-IV DLBCL patients with an aaIPI of 1-3.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Treatment
Type: Publication Only
Background
The 2014 Dutch national clinical practice guideline for diffuse large B-cell lymphoma (DLBCL) recommends 8x R-CHOP21 or 6x R-CHOP14 followed by 2 additional cycles of rituximab (2R) as first line therapy for stage II-IV DLBCL patients with an age-adjusted International Prognostic Index (aaIPI) of 1-3. However, international guidelines tend to promote 6x R-CHOP21 as the preferred first line treatment.
Aims
The aim of this population-based study was to evaluate which treatment regimens were applied in the Netherlands.
Methods
We selected 840 patients diagnosed in 2014 with stage II-IV DLBCL and aaIPI 1-3 (median [range] age 69 years [18-99]; 55% male) from the nationwide population-based Netherlands Cancer Registry. All patients were treated outside clinical trials. In this study, first line treatment was defined as 6x or 8x R-CHOP14/21, and, in case of 6x R-CHOP14/21, with or without 2R. Overall response rate (ORR) was defined as achieving complete or partial response, i.e. CR(u) or PR. Data were analyzed for the total cohort, as well as stratified by age and treatment regimen.
Results
Treatment with R-CHOP14/21 was initiated in 651 (78%) patients, while 103 (12%) patients received other (chemo)therapeutic regimens. The remaining 86 (10%) patients received no therapy. Of those who received R-CHOP14/21, 508 (78%) completed 6x or 8x, 122 (19%) received less than 6x, and 21 (3%) received 7x.Of the patients who completed treatment (6x +/- 2R or 8x), 6x R-CHOP21, 6x R-CHOP21+2R and 8x R-CHOP21 regimens were provided in 21%, 20% and 45% of patients, while 6x R-CHOP14, 6x R-CHOP14+2R and 8x R-CHOP14 in 3%, 3% and 8% of patients, respectively. Of note, 8x R-CHOP14/21 was most commonly applied (53%; N=269).Patients aged <65 years (N=233) more often received 8x (82%), whereas patients aged ≥65 years more often received 6x (72%).As for patients aged 65-74 years (N=160), 39 (24%) patients received 6x R-CHOP21, 49 (31%) 6x R-CHOP21+2R and 55 (34%) 8x R-CHOP21. Only 17 (11%) patients received 6x R-CHOP14 +/- 2R or 8x R-CHOP14.For patients aged ≥75 years (N=115), all but one received R-CHOP21 regimens, of which 43% received 6x, 39% 6x with 2R and 17% 8x.The ORR was 88% (448/508) for patients who completed treatment. Further, the ORR was 87% for 8x R-CHOP21, 83% for 6x R-CHOP21 and 94% for 6x R-CHOP14+2R and this was irrespective of age group.
Conclusion
Our results show that treatment with R-CHOP was initiated in 78% of patients with stage II-IV DLBCL and an aaIPI of 1-3. Three-weekly regimens were applied to 85% of patients who completed treatment. Although based on modest patient numbers, the ORR for 6x R-CHOP21, which is the internationally preferred R-CHOP regimen, was 83%. That value compares somewhat lower to the ORRs in the 8x R-CHOP21 and 6x R-CHOP14+2R groups, i.e. 87% and 94%, respectively. Collectively, these population-based analyses demonstrate that there is variation in the provision of R-CHOP regimens in daily practice, which could be related to the ongoing debate among clinicians in the Netherlands whether 6x or 8x R-CHOP21 should be the standard of care as first line therapy for stage II-IV DLBCL patients with an aaIPI of 1-3.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Treatment
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