Division of Hematology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Support Care Cancer. 2021 Sep;29(9):5197-5207. doi: 10.1007/s00520-021-06059-2. Epub 2021 Feb 24.
A combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard first-line therapy for diffuse large B cell lymphoma (DLBCL), the most common aggressive lymphoma in adults. One of the major adverse effects of this regimen is vincristine-induced polyneuropathy which leads to discontinuation of vincristine in up to 30% of DLBCL-patients. Dose reduction of vincristine might worsen treatment outcomes of DLBCL but identification of treatment alternatives for patients exhibiting peripheral neuropathy during R-CHOP is an unmet need in hematology.
In this retrospective cohort study, comprising 987 patients with de novo DLBCL, we delineated the role of vinorelbine as a substitute for vincristine in R-CHOP by measuring improvements in neuropathy and outcome variables.
Five-year overall survival (OS) and progression-free survival (PFS) were 72.6% and 63.1% in patients who received regular doses of vincristine, as compared to 60.6% and 51.7% in patients who received reduced doses of vincristine (p = 0.022 and p = 0.003, respectively). Of 199 patients who switched to vinorelbine, the majority experienced an improvement of neuropathy Furthermore, vinorelbine-switched patients showed favorable oncologic outcomes.
Replacement of vincristine by vinorelbine due to neuropathy is effective and safe, and results in a significant improvement in neuropathy as compared to treatment with R-CHOP.
利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）是弥漫性大 B 细胞淋巴瘤（DLBCL）的标准一线治疗方案，DLBCL 是成人中最常见的侵袭性淋巴瘤。该方案的主要不良反应之一是长春新碱引起的多发性神经病，导致多达 30%的 DLBCL 患者停止使用长春新碱。长春新碱剂量减少可能会恶化 DLBCL 的治疗效果，但对于在 R-CHOP 期间出现周围神经病变的患者，寻找替代治疗方法是血液学领域尚未满足的需求。
在这项包括 987 例初治 DLBCL 患者的回顾性队列研究中，我们通过测量神经病和结局变量的改善，明确了长春瑞滨替代长春新碱在 R-CHOP 中的作用。
接受常规剂量长春新碱治疗的患者 5 年总生存（OS）率和无进展生存（PFS）率分别为 72.6%和 63.1%，而接受长春新碱减剂量治疗的患者分别为 60.6%和 51.7%（p = 0.022 和 p = 0.003）。在 199 例改用长春瑞滨的患者中，大多数患者的神经病得到改善。此外，改用长春瑞滨的患者表现出良好的肿瘤学结局。
由于神经病而用长春瑞滨替代长春新碱是有效且安全的，与 R-CHOP 治疗相比，可显著改善神经病。
