Dose-intensified CHOP with rituximab (R-Double-CHOP) followed by consolidation high-dose chemotherapies for patients with advanced diffuse large B-cell lymphoma

• Published in: International journal of hematology Vol. 101; no. 6; pp. 585 - 593
• Main Authors: Kurita, Daisuke, Miura, Katsuhiro, Nakagawa, Masaru, Ohtake, Shimon, Sakagami, Masashi, Uchino, Yoshihito, Takahashi, Hiromichi, Kiso, Satomi, Hojo, Atsuko, Kodaira, Hitomi, Yagi, Mai, Hirabayashi, Yukio, Kobayashi, Yujin, Iriyama, Noriyoshi, Kobayashi, Sumiko, Hatta, Yoshihiro, Kura, Yoshimasa, Sugitani, Masahiko, Takei, Masami
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.06.2015; Springer Nature B.V
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Disease-Free Survival; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Female; Hematology; Humans; Immunologic Factors - administration & dosage; Immunologic Factors - adverse effects; Immunologic Factors - therapeutic use; Kaplan-Meier Estimate; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - pathology; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Prednisone - administration & dosage; Prednisone - adverse effects; Prednisone - therapeutic use; Rituximab - administration & dosage; Rituximab - adverse effects; Rituximab - therapeutic use; Stem Cell Transplantation; Treatment Outcome; Vincristine - administration & dosage; Vincristine - adverse effects; Vincristine - therapeutic use; Young Adult; Rituximab; Transplantation; High-dose chemotherapy; Diffuse large B-cell lymphoma
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-015-1780-6

Even after the advent of rituximab, clinical outcomes of conventional immuno-chemotherapy for high-risk diffuse large B-cell lymphoma (DLBCL) remain unsatisfactory. We retrospectively evaluated the efficacy and safety of R-Double-CHOP (R-D-CHOP), consisting of rituximab (375 mg/m 2 , day −2), cyclophosphamide (750 mg/m 2 , day 1, 2), doxorubicin (50 mg/m 2 , day 1, 2), vincristine [1.4 mg/m 2 (maximum 2.0 mg/body), day 1], and prednisolone (50 mg/m 2 , day 1–5), followed by consolidation high-dose chemotherapy. This treatment was given to 51 de novo DLBCL patients with a median age of 54 (range 19–65), who were categorized as high/high-intermediate risk by the age-adjusted International Prognostic Index. Treatment was given every 3 weeks up to three courses. The overall response and the complete response rate for R-D-CHOP were 94 and 78 %, respectively. A total of 30 responders proceeded to high-dose chemotherapy followed by autologous stem cell transplantation (HDC/ASCT), whereas 16 received high-dose methotrexate (HD-MTX) alternatively. The 3-year overall survival and the event-free survival for all patients were 78 and 61 %, respectively. Major adverse events included hematological toxicities, but there were no treatment-related deaths during the observation period. We conclude that the R-D-CHOP regimen followed by HDC/ASCT or HD-MTX is a promising treatment option for younger patients with highly advanced DLBCL.