Multicenter Phase 2 Study of Reduced-Dose CHOP Chemotherapy Combined With Rituximab for Elderly Patients With Diffuse Large B-Cell Lymphoma

Abstract

We assessed 53 patients aged >= 65 years in South Korea to evaluate the efficacy and toxicity of reduced-dose (RD) rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy for elderly patients with diffuse large B-cell lymphoma. RD-R-CHOP chemotherapy showed comparable survival benefits compared to those who received previous RD-R-CHOP-like chemotherapy. Introduction: Elderly patients are more prone to encounter some adverse factors when they receive chemotherapy compared to younger patients. Addition of rituximab to a reduced dose (RD) of cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy might improve patient outcomes with an improved toxicity profile when provided to elderly patients with diffuse large B-cell lymphoma. Patients and Methods: A total of 53 patients aged >= 65 years with diffuse large B-cell lymphoma diagnosed between August 2012 and December 2014 were enrolled onto this study. RD-R-CHOP regimen consisted of rituximab at 375 mg/m(2), cyclophosphamide at 600 mg/m(2), doxorubicin at 30 mg/m(2), and vincristine at 1 mg on day 1 of each cycle and 40 mg of prednisone on days 1 to 5. Patients received granulocyte colony-stimulating factor if they experienced grade 3/4 neutropenia or febrile neutropenia during any cycle. Results: The median follow-up duration was 18 months (range, 1-44 months). Complete response and overall response rates were 64.1% and 81.1%, respectively. Three-year event-free and overall survival rates were 45.7% +/- 8.4% and 62.7% +/- 8.1%, respectively. Grade 3/4 neutropenia occurred in 20 patients (37.7%), while febrile neutropenia occurred in 7 patients (20.7%). Conclusion: Outcomes of RD-R-CHOP chemotherapy were comparable to those of standard-dose R-CHOP or previous dose-adjusted R-CHOP chemotherapy. In the future, strategies such as tailored therapy based on geriatric assessment results are needed to determine the chemotherapeutic dosage.