Impact of relative dose intensity (RDI) in CHOP combined with rituximab (R-CHOP) on survival in diffuse large B-cell lymphoma

Abstract

BackgroundRecently, maintaining higher relative dose intensity (RDI) of chemotherapeutic drugs has become a widespread practice in an attempt to achieve better outcomes in the treatment of aggressive lymphoma. The addition of rituximab to chemotherapy regimens has significantly improved outcome in diffuse large B-cell lymphoma (DLBL). However, it is unknown if higher RDI in chemotherapy when combined with rituximab leads to a better outcome in aggressive B-cell lymphoma.MethodsWe retrospectively evaluated the impact of the RDI of initial chemotherapy (consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone with rituximab (R-CHOP) on outcome in 100 newly diagnosed DLBL patients.ResultsA multivariate Cox regression model showed that RDI trended towards a significant association with mortality [hazard ratio per 0.1 of RDI = 0.8; 95% confidence interval 0.6–1.0; P = 0.08]. Additionally, on multivariate logistic analysis, advanced age was a significant factor for reduced RDI.ConclusionOur data suggest that in DLBL patients, mortality was affected by RDI of R-CHOP as the initial treatment, and the retention of a high RDI could therefore be crucial.

Clinical prognostic factors of diffuse large B cell non-Hodgkin lymphoma: A retrospective study

“…Hirakawa et al reported the OS at 2 years to be significantly higher in patients in whom the ARDI was maintained at 70% or more, while the PFS at 2 years tended to be higher in patients in whom the ARDI was maintained at 70% or more [21], while in our study DFS was not affected by DI and RDI of doxorubicin (p = 0.35) or cyclophosphamide (p = 0.386). Terada et al retrospectively evaluated the impact of the RDI of initial R-CHOP on outcome in newly diagnosed DLBCL patients and reported that mortality was affected by RDI of R-CHOP as the initial treatment [22].…”

Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET

“…The relative dose intensity (RDI) was calculated by averaging the relative total dose intensities of the 3 agents over all treatment courses. 23 …”

Impact of dose intensity on outcome of fludarabine, cyclophosphamide, and rituximab regimen given in the first-line therapy for chronic lymphocytic leukemia

“…10 Since the introduction of rituximab, four independent studies, including our own, 11 have described similar findings with 10-30% of reduced RDI resulting in decreased PFS and OS in DLBCL patients. [11][12][13][14] Impact of dose intensity on outcome of fludarabine, cyclophosphamide, and rituximab regimen given in the first-line therapy for chronic lymphocytic leukemia to note that all these studies are retrospective and focused on patients treated outside the setting of clinical trials. However, very little is known about the impact of RDI in indolent lymphomas, including CLL.…”