Outcome and determinants of failure to complete primary R‐CHOP treatment for reasons other than non‐response among patients with diffuse large B‐cell lymphoma

Abstract

Patients with diffuse large B‐cell lymphoma (DLBCL) who fail to complete planned treatment with R‐CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R‐CHOP for reasons unrelated to non‐response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R‐CHOP were identified through the Swedish lymphoma register 2007‐2014. Of these, 147 (5%) stopped prematurely after 1‐3 cycles of R‐CHOP for reasons unrelated to non‐response, 168 (5%) after 4‐5 cycles and 2639 patients (84%) completed planned treatment. Additionally, 195 (6%) patients did not complete treatment due to non‐response or death before treatment end. In a multivariable logistic regression model, age > 75 years, poor performance status, extranodal disease and Charlson Comorbidity Index ≥1 were significantly associated with failure to complete planned R‐CHOP treatment for other reasons than non‐response. Non‐completion of treatment strongly correlated with survival. Five‐year overall survival for patients who received 1‐3 cycles was 26% (95% CI: 19%‐33%), 49% (95% CI: 41%‐57%) for 4‐5 cycles and 76% (74%‐77%) for patients who completed treatment. Failure to complete planned R‐CHOP treatment is an important clinical issue associated with inferior survival. Old age and poor performance status most strongly predict such failure. These results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.

Nomogram for Predicting the Overall Survival of Adult Patients With Primary Gastrointestinal Diffuse Large B Cell Lymphoma: A SEER- Based Study

“…The second limitation of this study is its retrospective nature, data integrity, and homogeneity are not guaranteed. Nevertheless, the patient population is relatively sufficient, and the findings of prognostic factors are consistent with other studies (31,36,37). Finally, treatment regimens of included patients were unclear.…”

TRAIL Score: A Simple Model to Predict Immunochemotherapy Tolerability in Patients With Diffuse Large B-Cell Lymphoma

“…Risk factors associated with premature discontinuation of R-CHOP therapy included advanced age, poor performance status, elevated lactate dehydrogenase levels, presence of extranodal disease, and stage IV disease. 11 Similar results were seen in another observational population-based cohort study. 7 Among 70 patients with DLBCL age ≥ 75 years treated with R-CHOP, 39 completed the planned course of treatment.…”

Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy

“…The most common approach to influence VIPN during R-CHOP treatment is dose reduction or discontinuation of vincristine. However, there is increasing evidence that dose-dense chemotherapy is seminal for improving remission and survival rates [16][17][18][19][20]. To the best of our knowledge, there are only two published studies focusing on the issue of vincristine dose reduction in DLBCL patients delivering contradictory results regarding survival outcomes [19,40].…”

“…Dose reduction or discontinuation of vincristine has been commonly used to ameliorate VIPN in R-CHOP-treated DLBCL patients, although this practice is likely associated with impaired treatment outcomes and higher lymphomarelated mortality [16][17][18][19][20]. Nevertheless, there is a lack of studies focusing explicitly on VIPN and the consequences of vincristine dose reductions.…”