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Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14
DLBCL is an aggressive lymphoma treated with R-CHOP. Recently, attempts have been made to improve the outcome by increasing both dose-density and intensity but there have been no benefits in terms of survival. When treating malignancies RDI is important to consider but there is little published info...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409365/ https://www.ncbi.nlm.nih.gov/pubmed/25909361 http://dx.doi.org/10.1371/journal.pone.0123978 |
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author | Gutiérrez, Antonio Bento, Leyre Bautista-Gili, Antonia Maria Garcia, Francesc Martinez-Serra, Jordi Sanchez, Blanca Martorell, Clara Gines, Jordi Garcia, Lucia Gimeno, Eva Ferraro, Mariana Del Campo, Raquel Bargay, Joan Perez, Albert Vercher, Javier Scaff, Miguel Pacheco, Ana Ballester, Carmen Garcia, Florencia Ramos, Rafael Salar, Antonio Besalduch, Joan |
author_facet | Gutiérrez, Antonio Bento, Leyre Bautista-Gili, Antonia Maria Garcia, Francesc Martinez-Serra, Jordi Sanchez, Blanca Martorell, Clara Gines, Jordi Garcia, Lucia Gimeno, Eva Ferraro, Mariana Del Campo, Raquel Bargay, Joan Perez, Albert Vercher, Javier Scaff, Miguel Pacheco, Ana Ballester, Carmen Garcia, Florencia Ramos, Rafael Salar, Antonio Besalduch, Joan |
author_sort | Gutiérrez, Antonio |
collection | PubMed |
description | DLBCL is an aggressive lymphoma treated with R-CHOP. Recently, attempts have been made to improve the outcome by increasing both dose-density and intensity but there have been no benefits in terms of survival. When treating malignancies RDI is important to consider but there is little published information on DLBCL. The purpose of this study was to analyze the differential prognostic impact of RDI in two cohorts of DLBCL patients treated with R-CHOP21 or R-CHOP14. From January 2001 to August 2013 we included DLBCL patients homogenously treated with R-CHOP21 or R-CHOP14, with or without radiotherapy, at University Hospital Son Espases, Hospital Son Llatzer of Palma and Hospital del Mar of Barcelona (N = 157). In order to avoid selection bias the patients were retrospectively identified from the Pathology Department and Pharmacy registries. Median follow-up was 68 months. There was no difference in the response or survival between the two cohorts. In the R-CHOP21 group, both a reduction higher than 15% in RDI (RR 7.41) and R-IPI (RR 2.99) were independently associated with OS. However, a reduction higher than 15% in RDI (RR 4.41) was only noted for PFS. In the R-CHOP14 group, NCCN-IPI (RR 7.09) and B-symptoms (RR 5.37) for OS; AA stage III-IV (RR 6.26) and bulky disease (RR 4.05) for PFS. There was a trend towards a higher rate of RDI reduction observed in the R-CHOP14 group but it only made an impact in the R-CHOP21 group. We conclude that R-CHOP21 and R-CHOP14 are equivalent regimens in terms of response and survival, but only if RDI reductions are avoided. For patients receiving R-CHOP21 we recommend using clinical and support measures in order to avoid RDI reductions. |
format | Online Article Text |
id | pubmed-4409365 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-44093652015-05-12 Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14 Gutiérrez, Antonio Bento, Leyre Bautista-Gili, Antonia Maria Garcia, Francesc Martinez-Serra, Jordi Sanchez, Blanca Martorell, Clara Gines, Jordi Garcia, Lucia Gimeno, Eva Ferraro, Mariana Del Campo, Raquel Bargay, Joan Perez, Albert Vercher, Javier Scaff, Miguel Pacheco, Ana Ballester, Carmen Garcia, Florencia Ramos, Rafael Salar, Antonio Besalduch, Joan PLoS One Research Article DLBCL is an aggressive lymphoma treated with R-CHOP. Recently, attempts have been made to improve the outcome by increasing both dose-density and intensity but there have been no benefits in terms of survival. When treating malignancies RDI is important to consider but there is little published information on DLBCL. The purpose of this study was to analyze the differential prognostic impact of RDI in two cohorts of DLBCL patients treated with R-CHOP21 or R-CHOP14. From January 2001 to August 2013 we included DLBCL patients homogenously treated with R-CHOP21 or R-CHOP14, with or without radiotherapy, at University Hospital Son Espases, Hospital Son Llatzer of Palma and Hospital del Mar of Barcelona (N = 157). In order to avoid selection bias the patients were retrospectively identified from the Pathology Department and Pharmacy registries. Median follow-up was 68 months. There was no difference in the response or survival between the two cohorts. In the R-CHOP21 group, both a reduction higher than 15% in RDI (RR 7.41) and R-IPI (RR 2.99) were independently associated with OS. However, a reduction higher than 15% in RDI (RR 4.41) was only noted for PFS. In the R-CHOP14 group, NCCN-IPI (RR 7.09) and B-symptoms (RR 5.37) for OS; AA stage III-IV (RR 6.26) and bulky disease (RR 4.05) for PFS. There was a trend towards a higher rate of RDI reduction observed in the R-CHOP14 group but it only made an impact in the R-CHOP21 group. We conclude that R-CHOP21 and R-CHOP14 are equivalent regimens in terms of response and survival, but only if RDI reductions are avoided. For patients receiving R-CHOP21 we recommend using clinical and support measures in order to avoid RDI reductions. Public Library of Science 2015-04-24 /pmc/articles/PMC4409365/ /pubmed/25909361 http://dx.doi.org/10.1371/journal.pone.0123978 Text en © 2015 Gutiérrez et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Gutiérrez, Antonio Bento, Leyre Bautista-Gili, Antonia Maria Garcia, Francesc Martinez-Serra, Jordi Sanchez, Blanca Martorell, Clara Gines, Jordi Garcia, Lucia Gimeno, Eva Ferraro, Mariana Del Campo, Raquel Bargay, Joan Perez, Albert Vercher, Javier Scaff, Miguel Pacheco, Ana Ballester, Carmen Garcia, Florencia Ramos, Rafael Salar, Antonio Besalduch, Joan Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14 |
title | Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14 |
title_full | Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14 |
title_fullStr | Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14 |
title_full_unstemmed | Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14 |
title_short | Differential Impact of Relative Dose-Intensity Reductions in Diffuse Large B-Cell Lymphoma Treated with R-CHOP21 or R-CHOP14 |
title_sort | differential impact of relative dose-intensity reductions in diffuse large b-cell lymphoma treated with r-chop21 or r-chop14 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409365/ https://www.ncbi.nlm.nih.gov/pubmed/25909361 http://dx.doi.org/10.1371/journal.pone.0123978 |
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