Tumor Center, Nihon University Itabashi Hospital (Director); 2Department of Hematology and Rheumatology, Nihon University School of Medicine (Associate Professor), Tokyo, Japan.
Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.
Expert Rev Anticancer Ther. 2022 Jun;22(6):583-595. doi: 10.1080/14737140.2022.2071262. Epub 2022 May 5.
The standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, its ideal dose intensity varies among cases.
This review provides the latest insights on the dose intensity of R-CHOP for DLBCL patients. Specifically, we discussed the optimal dose intensity for elderly patients, the optimal number of treatment cycles for limited or advanced-stage diseases, and the role of dose-intensified therapies or adding targeted inhibitors.
Performing a comprehensive or simplified geriatric assessment can distinguish elderly DLBCL patients who will likely benefit from curative R-CHOP. Very elderly or medically unfit patients may need dose reduction in R-CHOP; the Age, Comorbidities, and Albumin index may aid decision-making. Four cycles of R-CHOP followed by two rituximab cycles comprise a new standard for low-risk, limited-stage DLBCL patients. Compared to eight cycles, six cycles of R-CHOP have similar efficacy and fewer toxicities for advanced-stage DLBCL. Dose-intensified therapy is not recommended in most DLBCL cases but may be considered for patients with double (or triple)-hit lymphoma. Applying targeted inhibitors and not merely escalating R-CHOP dose intensity through molecular subtyping will improve the treatment outcome for DLBCL.
弥漫性大 B 细胞淋巴瘤（DLBCL）的标准治疗方案是利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）。然而，其理想的剂量强度因病例而异。
本篇综述提供了关于 R-CHOP 治疗 DLBCL 患者剂量强度的最新见解。具体而言，我们讨论了老年患者的最佳剂量强度、局限性或晚期疾病的最佳治疗周期数，以及强化治疗或添加靶向抑制剂的作用。
进行全面或简化的老年评估可以区分出可能从根治性 R-CHOP 中获益的老年 DLBCL 患者。非常高龄或身体状况不佳的患者可能需要减少 R-CHOP 的剂量；年龄、合并症和白蛋白指数可辅助决策。对于低危、局限性 DLBCL 患者，四周期 R-CHOP 加两周期利妥昔单抗已成为新标准。与八周期相比，六周期 R-CHOP 治疗晚期 DLBCL 的疗效相当，但毒性更小。强化治疗在大多数 DLBCL 病例中不推荐，但对于双（或三）打击淋巴瘤患者可能需要考虑。应用靶向抑制剂，而不仅仅是通过分子分型增加 R-CHOP 剂量强度，将改善 DLBCL 的治疗结果。
