What are the alternatives to CHOP for the treatment of advance-stage diffuse large cell lymphoma

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

In the last decade, 2 alternative chemotherapy regimens were evaluated against standard CHOP in patients with advanced DLBCL. The Groupe d'Etude des Lymphomes de l'Adulte (GELA) compared the efficacy of doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) against CHOP-21 in 635 patients aged 61-69 years with advanced-stage DLBCL with at least one International Prognostic Index (IPI) score risk factor. [93]

While the complete response rate was similar between the 2 groups (58% vs 56%), the event-free survival (EFS) and OS rates were significantly better in patients treated with ACVBP than in those treated with CHOP-21. At 5 years of follow up, the EFS was 39% in the ACVBP groups and 29% in the CHOP-21 group (P =.005) and the OS was significantly longer for patients treated with ACVBP (46%) than patients treated with CHOP-21 (38%, P =.036). Of interest, CNS progressions or relapses were more frequent in the CHOP-21 group (P =.004). [93]

The German Study Lymphoma Group (GSLG) evaluated the concept of dose-dense in DLBCL patients. Elderly patients with DLBCL were randomized into 4 cohorts and received CHOP-21 (given every 21 days) with or without etoposide (E) or dose-dense CHOP (given every 14 days, CHOP-14) with or without etoposide. The addition of etoposide to CHOP chemotherapy did not affect the clinical end points of the study. On the other hand, the delivery of CHOP in a dose-dense schema proved superior in terms of PFS and OS with a similar toxicity profile (43.8% vs 32.5%, P =.003 and 53.3% vs 40.6%, P< .001). [94]

A subsequent study, the NHL-B1, evaluated the same regimens in young patients with advanced DLBCL. The study confirmed the value of dose-dense CHOP, and, of interest, in younger patients with DLBCL, the addition of etoposide to CHOP (CHOEP-14 or CHOEP-21) was associated with better PFS and OS when compared with CHOP-21. In spite of an increased degree of myelosuppression, these regimens were well tolerated. [95]


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