Journal Article

Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial

Fitoussi, Olivier, Tilly, Hervé, Petrella, Tony, Thyss, Antoine, Delmer, Alain, Hacini, Maya, Ysebaert, Loïc, Ghesquières, Hervé, Thieblemont, Catherine, Bologna, Serge, Delarue, Richard, Van Hoof, Achiel, Fermé, Christophe, Salles, Gilles, Bosly, André, Mounier, Nicolas, Haioun, Corinne, Fruchart, Christophe, Molina, Thierry Jo, Casasnovas, Olivier

2013

Overview

Immunochemotherapy with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has become the standard of care for elderly patients with diffuse large B-cell lymphoma. We aimed to ascertain if a dose-dense R-CHOP regimen administered every 2 weeks (R-CHOP14) was superior to the standard 3-week schedule (R-CHOP21). We did a randomised phase 3 trial at 83 centres in four countries. 602 patients aged 60–80 years with untreated diffuse large B-cell lymphoma and at least one adverse prognostic factor (age-adjusted international prognostic index ≥1) were eligible for the study. We randomly allocated individuals to R-CHOP—ie, rituximab (375 mg/m2), cyclophosphamide (750 mg/m2), doxorubicin (50 mg/m2), vincristine (1·4 mg/m2, up to 2 mg) all on day 1, and prednisone 40 mg/m2 daily for 5 days—administered every 14 days (n=304) or every 21 days (n=298) for eight cycles. We did permuted-block randomisation (block size four, allocation ratio 1:1) stratified by centre and number of adverse prognostic factors. The primary endpoint was event-free survival. Our analysis was of the intention-to-treat population, and we present the final analysis. This study is registered with ClinicalTrials.gov, number NCT00144755. Two patients allocated R-CHOP21 were ineligible for the study and were excluded from analyses. After median follow-up of 56 months (IQR 27–60), 3-year event-free survival was 56% (95% CI 50–62) in the R-CHOP14 group and 60% (55–66) in the R-CHOP21 group (hazard ratio 1·04, 95% CI 0·82–1·31; p=0·7614). Grade 3–4 neutropenia occurred in 224 (74%) of 304 patients allocated R-CHOP14 and 189 (64%) of 296 assigned R-CHOP21, despite increased use of granulocyte colony-stimulating factor in the R-CHOP14 group compared with the R-CHOP21 group. 143 (47%) patients in the R-CHOP14 group received at least one red-blood-cell transfusion versus 93 (31%) in the R-CHOP21 group (p=0·0001). 35 (12%) patients allocated R-CHOP14 received at least one platelet transfusion versus 25 (8%) assigned R-CHOP21 (p=0·2156). 155 (51%) patients who were assigned R-CHOP14 had at least one serious adverse event compared with 140 (47%) who were allocated R-CHOP21. In elderly patients with untreated diffuse large B-cell lymphoma and at least one adverse prognostic factor, a 2-week dose-dense R-CHOP regimen did not improve efficacy compared with the 3-week standard schedule. The frequency of toxic side-effects was similar between regimens, but R-CHOP14 was associated with increased need for red-blood-cell transfusion. Groupe d'Etude des Lymphomes de l'Adulte (GELA), Amgen.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Age Factors / Aged / Aged, 80 and over / Antibodies, Monoclonal, Murine-Derived - administration & dosage / Antineoplastic Combined Chemotherapy Protocols - adverse effects / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Bone marrow / Chemotherapy / Chi-Square Distribution / Cyclophosphamide - administration & dosage / Disease-Free Survival / Doxorubicin - administration & dosage / Drug Administration Schedule / Drug dosages / Europe / Female / Hematology / Hematology, Oncology and Palliative Medicine / Hepatitis / Humans / Intention to Treat Analysis / Kaplan-Meier Estimate / Lymphoma / Lymphoma, Large B-Cell, Diffuse - drug therapy / Lymphoma, Large B-Cell, Diffuse - mortality / Male / Middle Aged / Neutrophils / Oncology / Prednisone - administration & dosage / Proportional Hazards Models / Rituximab / Time Factors / Toxicity / Treatment Outcome / Tumors / Vincristine - administration & dosage