Centre for Lymphoid Cancer, BC Cancer and The University of British Columbia, Vancouver, BC, Canada.
Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Blood Adv. 2021 Mar 9;5(5):1483-1489. doi: 10.1182/bloodadvances.2020002982.
Doxorubicin plays an integral role in the treatment of patients with diffuse large B-cell lymphoma (DLBCL) but can be associated with significant toxicity. Treatment guidelines of British Columbia (BC) Cancer recommend the substitution of etoposide for doxorubicin in standard-dose R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) (R-CEOP) for patients who have a contraindication to anthracyclines; however, it is unknown if this compromises treatment outcome. We identified all patients with newly diagnosed DLBCL who were treated in BC with curative intent with R-CEOP (n = 70) within the study period. Outcome in this population was compared with a 2:1 case-matched control group (n = 140) treated with R-CHOP and matched for age, clinical stage, and International Prognostic Index score. The 10-year time to progression and disease-specific survival were not significantly different for patients treated with R-CEOP compared with patients in the R-CHOP control group (53% vs 62% [P = .089] and 58% vs 67% [P = .251], respectively). The 10-year overall survival was lower in the R-CEOP group (30% vs 49%, P = .002), reflecting the impact of underlying comorbidities and frailty of this population. R-CEOP represents a useful treatment alternative for patients with DLBCL and an absolute contraindication to the use of anthracyclines, with curative potential.
多柔比星在治疗弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者中起着重要作用，但也可能导致严重的毒性。不列颠哥伦比亚癌症治疗指南建议，对于有蒽环类药物禁忌证的患者，用依托泊苷替代标准剂量 R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松）（R-CEOP）治疗；然而，目前尚不清楚这是否会影响治疗效果。在研究期间，我们确定了所有在不列颠哥伦比亚省接受治愈性 R-CEOP 治疗的新诊断为 DLBCL 且有明确蒽环类药物禁忌证的患者（n=70）。该人群的预后与接受 R-CHOP 治疗的 2:1 病例匹配对照人群（n=140）进行了比较，并且匹配了年龄、临床分期和国际预后指数评分。与 R-CHOP 对照组相比，接受 R-CEOP 治疗的患者在 10 年无进展时间和疾病特异性生存方面没有显著差异（53%比 62%[P=0.089]和 58%比 67%[P=0.251]）。R-CEOP 组的 10 年总生存率较低（30%比 49%，P=0.002），这反映了该人群基础合并症和虚弱的影响。R-CEOP 是治疗对蒽环类药物绝对禁忌的 DLBCL 患者的有效治疗选择，具有治愈潜力。
