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Outcome and determinants of failure to complete primary R-CHOP treatment for reasons other than non-response among patients with diffuse large B-cell lymphoma

Wästerlid, Tove LU ; Harrysson, Sara ; Andersson, Therese M.L. ; Ekberg, Sara ; Enblad, Gunilla ; Andersson, Per Ola ; Jerkeman, Mats LU ; Eloranta, Sandra and Smedby, Karin E. (2020) In American Journal of Hematology 95(7). p.740-748
Abstract

Patients with diffuse large B-cell lymphoma (DLBCL) who fail to complete planned treatment with R-CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R-CHOP for reasons unrelated to non-response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R-CHOP were identified through the Swedish lymphoma register 2007-2014. Of these, 147 (5%) stopped prematurely after 1-3 cycles of R-CHOP for reasons unrelated to non-response, 168 (5%) after 4-5 cycles and 2639 patients (84%) completed planned... (More)

Patients with diffuse large B-cell lymphoma (DLBCL) who fail to complete planned treatment with R-CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R-CHOP for reasons unrelated to non-response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R-CHOP were identified through the Swedish lymphoma register 2007-2014. Of these, 147 (5%) stopped prematurely after 1-3 cycles of R-CHOP for reasons unrelated to non-response, 168 (5%) after 4-5 cycles and 2639 patients (84%) completed planned treatment. Additionally, 195 (6%) patients did not complete treatment due to non-response or death before treatment end. In a multivariable logistic regression model, age > 75 years, poor performance status, extranodal disease and Charlson Comorbidity Index ≥1 were significantly associated with failure to complete planned R-CHOP treatment for other reasons than non-response. Non-completion of treatment strongly correlated with survival. Five-year overall survival for patients who received 1-3 cycles was 26% (95% CI: 19%-33%), 49% (95% CI: 41%-57%) for 4-5 cycles and 76% (74%-77%) for patients who completed treatment. Failure to complete planned R-CHOP treatment is an important clinical issue associated with inferior survival. Old age and poor performance status most strongly predict such failure. These results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.

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type
Contribution to journal
publication status
published
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in
American Journal of Hematology
volume
95
issue
7
pages
9 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:32180274
  • scopus:85084647826
ISSN
0361-8609
DOI
10.1002/ajh.25789
language
English
LU publication?
yes
id
8f33c5a4-f783-4395-b79c-97ddc64cb3c2
date added to LUP
2020-05-27 12:19:26
date last changed
2025-01-09 12:02:54
@article{8f33c5a4-f783-4395-b79c-97ddc64cb3c2,
  abstract     = {{<p>Patients with diffuse large B-cell lymphoma (DLBCL) who fail to complete planned treatment with R-CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R-CHOP for reasons unrelated to non-response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R-CHOP were identified through the Swedish lymphoma register 2007-2014. Of these, 147 (5%) stopped prematurely after 1-3 cycles of R-CHOP for reasons unrelated to non-response, 168 (5%) after 4-5 cycles and 2639 patients (84%) completed planned treatment. Additionally, 195 (6%) patients did not complete treatment due to non-response or death before treatment end. In a multivariable logistic regression model, age &gt; 75 years, poor performance status, extranodal disease and Charlson Comorbidity Index ≥1 were significantly associated with failure to complete planned R-CHOP treatment for other reasons than non-response. Non-completion of treatment strongly correlated with survival. Five-year overall survival for patients who received 1-3 cycles was 26% (95% CI: 19%-33%), 49% (95% CI: 41%-57%) for 4-5 cycles and 76% (74%-77%) for patients who completed treatment. Failure to complete planned R-CHOP treatment is an important clinical issue associated with inferior survival. Old age and poor performance status most strongly predict such failure. These results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.</p>}},
  author       = {{Wästerlid, Tove and Harrysson, Sara and Andersson, Therese M.L. and Ekberg, Sara and Enblad, Gunilla and Andersson, Per Ola and Jerkeman, Mats and Eloranta, Sandra and Smedby, Karin E.}},
  issn         = {{0361-8609}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{740--748}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{American Journal of Hematology}},
  title        = {{Outcome and determinants of failure to complete primary R-CHOP treatment for reasons other than non-response among patients with diffuse large B-cell lymphoma}},
  url          = {{http://dx.doi.org/10.1002/ajh.25789}},
  doi          = {{10.1002/ajh.25789}},
  volume       = {{95}},
  year         = {{2020}},
}