Diffuse large B-cell lymphoma

Four cycles of chemotherapy as effective as six

Jatros Digital, 01.12.2018
Onkologie | Hämatologie

A new study suggests the standard course of treatment for younger patients with low-risk DLBCL can safely be reduced by two cycles of chemotherapy. The trial, which tracked patients for a median of more than five years and up to 11 years, showed four cycles of chemotherapy is as effective as six cycles in terms of eradicating cancer and preventing relapse.

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma that tends to grow quickly. Most patients receive treatment in six cycles spaced three weeks apart. Each treatment cycle includes the chemotherapy regimen CHOP, which includes cyclophosphamide, doxorubicin, vincristine, and prednisone. Along with CHOP, patients receive rituximab. Rituximab is less toxic, and therefore has fewer side effects compared to chemotherapy.
For the study, researchers enrolled nearly 600 patients age 18–60 treated for DLBCL at institutions in Germany, Denmark, Norway, Italy, and Israel. All patients had stage I or II cancer and were considered to be low-risk. Half of the patients were randomly assigned to receive six cycles of CHOP and half received four cycles of CHOP. All patients received the standard six cycles of rituximab.
Patients did well with both treatment regimens, and there were no statistically significant differences between the two groups in terms of overall survival, relapse, or disease progression. Three years after receiving treatment, 99% of those receiving four cycles of chemotherapy and 98% of those receiving six cycles remained alive.
In addition, the data suggest that reducing the number of chemotherapy cycles also reduces the number of adverse events by one-third. Altogether, 1295 adverse events occurred in the 295 patients who underwent six cycles of chemotherapy compared with 835 adverse events in the 293 patients who received just four cycles of chemotherapy. „This is an important and meaningful benefit to patients,“ said lead study author Viola Poeschel, MD, of Saarland University Medical School in Homburg/Saar, Germany.
The health of study participants will be further tracked for an additional five years to determine whether decreasing the number of chemotherapy cycles may help reduce long-term side effects of chemotherapy.
Under the reduced regimen, chemotherapy lasts a total of 84 days, compared to 126 days with the six-cycle regimen. „With a shorter duration of chemotherapy, patients are back to daily life with their families and back to work more quickly,“ said Poeschel. „Our study shows you can spare two cycles of chemotherapy and it is equally effective. We think this will be the new standard treatment for this patient population.“

Poeschel V et al.: Excellent outcome of young patients (18–60 years) with favourable-prognosis diffuse large B-cell lymphoma (DLBCL) treated with 4 cycles CHOP plus 6 applications of rituximab: results of the 592 patients of the Flyer Trial of the Dshnhl/GLA. ASH Annual Meeting 2018, abstract #781