Long-term outcomes of R-CEOP show curative potential in patients with DLBCL and a contraindication to anthracyclines

Blood Adv. 2021 Mar 9;5(5):1483-1489. doi: 10.1182/bloodadvances.2020002982.

Abstract

Doxorubicin plays an integral role in the treatment of patients with diffuse large B-cell lymphoma (DLBCL) but can be associated with significant toxicity. Treatment guidelines of British Columbia (BC) Cancer recommend the substitution of etoposide for doxorubicin in standard-dose R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) (R-CEOP) for patients who have a contraindication to anthracyclines; however, it is unknown if this compromises treatment outcome. We identified all patients with newly diagnosed DLBCL who were treated in BC with curative intent with R-CEOP (n = 70) within the study period. Outcome in this population was compared with a 2:1 case-matched control group (n = 140) treated with R-CHOP and matched for age, clinical stage, and International Prognostic Index score. The 10-year time to progression and disease-specific survival were not significantly different for patients treated with R-CEOP compared with patients in the R-CHOP control group (53% vs 62% [P = .089] and 58% vs 67% [P = .251], respectively). The 10-year overall survival was lower in the R-CEOP group (30% vs 49%, P = .002), reflecting the impact of underlying comorbidities and frailty of this population. R-CEOP represents a useful treatment alternative for patients with DLBCL and an absolute contraindication to the use of anthracyclines, with curative potential.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anthracyclines* / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Contraindications
  • Cyclophosphamide / therapeutic use
  • Humans
  • Lymphoma, Large B-Cell, Diffuse* / drug therapy
  • Prognosis
  • Vincristine / therapeutic use

Substances

  • Anthracyclines
  • Vincristine
  • Cyclophosphamide