What is the role of the R-CHOP regimen in the treatment of diffuse large cell lymphoma?

Updated: Jun 12, 2019
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) regimen was among the first combinations to produce complete response rates and long-term survivors. For patients with advanced diffuse large cell lymphoma, another standard therapy exists; specifically, the addition of rituximab (Rituxan; a chimeric antibody that targets CD20+ B cells) to CHOP (R-CHOP). [70, 71, 72]

Rituximab produces a 48% response rate in patients with low-grade lymphomas [73] and has activity in diffuse large cell lymphoma.

A phase II pilot study of rituximab in combination with CHOP in patients with previously untreated diffuse large cell lymphoma or high-grade NHL reported an overall response rate of 97% (32 of 33 patients), with a 61% complete remission rate, a 36% partial remission rate, and a 3% progressive disease rate. [70] Severe adverse events were similar to those observed with CHOP alone.

In a study of 435 patients with diffuse large cell lymphoma, Villa et al found that the risk of CNS relapse was significantly reduced with the addition of rituximab to the CHOP regimen compared with risk reduction for patients treated with CHOP alone. [74] This reduction was even more evident in patients who achieved a complete response.

A study by Phan et al found that overall survival and progression-free survival were significantly improved among patients who received consolidation radiation treatment after undergoing R-CHOP therapy. [75]

A study of 215 patients treated with R-CHOP revealed improved event-free survival (EFS) in patients treated with epratuzumab plus R-CHOP (ER-CHOP). ER-CHOP is well tolerated, and these results suggest that combination therapy is promising. [76]

Récher et al compared the efficacy of R-CHOP with that of treatment consisting of rituximab added to a regimen of doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP) and found significant improvement in survival with the R-ACVBP regimen among patients aged 18-59 years with diffuse large B-cell lymphoma and low intermediate risk. [77]


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