POPULATION-BASED STUDY ON DIFFERENT REGIMENS OF R-CHOP IN PATIENTS WITH NEWLY DIAGNOSED DIFFUSE LARGE B-CELL LYMPHOMA IN THE NETHERLANDS SUPPORTS THE USE OF 6 CYCLES OF R-CHOP21
Author(s): ,
Djamila Issa
Affiliations:
Department of Hematology,JBZ,Den Bosch,Netherlands
,
Avinash Dinmohamed
Affiliations:
Department of Research,Netherlands Comprehensive Cancer Organisation (IKNL),Utrecht,Netherlands
,
Marielle Wondergem
Affiliations:
Department of Hematology,Amsterdam UMC, VU Medical Center,Amsterdam,Netherlands
,
Hedwig Blommestein
Affiliations:
Institute for Medical Technology Assessment,Erasmus School of Health Policy & Management, Erasmus University,Rotterdam,Netherlands
,
Pieternella Lugtenburg
Affiliations:
Department of Hematology,Erasmus MC Cancer Institute,Rotterdam,Netherlands
,
Otto Visser
Affiliations:
Department of Registration,Netherlands Comprehensive Cancer Organisation (IKNL),Utrecht,Netherlands
,
Sonja Zweegman
Affiliations:
Department of Hematology,Amsterdam UMC, VU Medical Center,Amsterdam,Netherlands
Martine Chamuleau
Affiliations:
Department of Hematology,Amsterdam UMC, VU Medical Center,Amsterdam,Netherlands
EHA Library. Issa D. Jun 14, 2019; 266095; PF295
Dr. Djamila Issa
Dr. Djamila Issa
Contributions
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Abstract

Abstract: PF295

Type: Poster Presentation

Presentation during EHA24: On Friday, June 14, 2019 from 17:30 - 19:00

Location: Poster area

Background
Randomized clinical trials (RCTs) showed similar efficacy between R-CHOP14 and R-CHOP21 regimens, and less toxicity with 6 v 8 cycles of R-CHOP when applied as first-line treatment among elderly (>60 years) DLBCL patients. Likewise, both 6x R-CHOP14 plus two cycles of rituximab (2R) and 8x R-CHOP21 result in comparable efficacy in patients 18-80 years. However, it is unknown whether the interval of 6x R-CHOP can be extended to 21 days especially among younger patients with advanced-stage DLBCL. Unfortunately, this question is unlikely to be addressed in future RCTs. In this regard, population-based studies can lend support to address unanswered hypotheses.

Aims

The aims of this population-based study among newly diagnosed DLBCL patients were two-fold. First, we sought to confirm results of RCTs on the effectiveness of R-CHOP21 v R-CHOP14, irrespective of the number of cycles (analysis A) and 6x v 8x R-CHOP, irrespective of dose density (analysis B). Secondly, we specifically assessed in patients aged 18-64 years whether 6x R-CHOP21±2R is equally effective as other R-CHOP regimens (analysis C).

Methods

We selected all patients aged ≥18 years diagnosed with advanced-stage DLBCL (stages II-IV) between 2004-2010 from the Dutch Population-based HAematological Registry for Observational Studies (PHAROS) and between 2014-2015 from the nationwide Netherlands Cancer Registry (NCR). Of note, the use of 2R after 6x R-CHOP was not uniformly registered in PHAROS. The primary endpoint was overall survival (OS) in age groups: 18-64, 65-74, and ≥75 years. Multivariable evaluation of OS was applied using Cox regression to account for some imbalances between treatment groups.

Results
The cohort for the first analysis included 2,338 patients who received ≥1 cycle of R-CHOP, of whom 637 (27%) received R-CHOP14 and 1,701 (73%) R-CHOP21. Recipients of R-CHOP21, as compared to recipients of R-CHOP14, were older (median age, 68 v 61 yrs; P<0.001) and more often had an IPI of ≥3 (47% v 38%; P<0.001). After multivariable analysis, the adjusted risk of mortality was similar between recipients of R-CHOP14 and R-CHOP21 across all age groups (Fig 1A for patients <65 yrs). In addition, R-CHOP14 was associated with more polyneuropathy, dose modifications and dose delays than R-CHOP21. Response rates were similar in both groups. For the secondary analysis of 6 vs 8 cycles, 1,892 patients were included. Analysis showed that 6 and 8 cycles were equally effective in all age groups (Fig 1B for patients <65 yrs). Not all patients received 2R after 6 cycles, but documentation was not reliable enough to draw conclusions.  6xR-CHOP21±2R was equally effective when compared to all other regimens in all patients (Fig 1C for patients <65 yrs).

Conclusion

Our population-based analyses add support to the notion from several RCTs that R-CHOP21 and R-CHOP14, and 6x and 8x R-CHOP are equally effective. Furthermore, 6x R-CHOP21±2R was found to be equally effective compared to all other regimens in all age groups. Therefore, 6xR-CHOP21 (±2R) should be considered the preferred first-line regimen for all patients with advanced-stage DLBCL. The question whether 2R after 6x CHOP21 can be omitted without compromising efficacy remains a topic for future studies.

Session topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): DLBCL, Survival, Treatment

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