3A Comparison between R-THP-COP and R-CHOP Regimens for the Treatment of Diffuse Large B-cell Lymphoma in Old Patients: A Single-institution Analysis

Abstract

Objective We retrospectively compared the clinical efficacy and toxicity of rituximab (R)-THP-COP (pirarubicin, cyclophosphamide, vincristine, and prednisolone) with that of R-CHOP (rituximab, adriamicin, cyclophosphamide, vincristine, and prednisolone) in previously untreated old patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods Patients admitted to our institution between 2004 and 2013 were examined. The patients received either R (375 mg/m², day 1)-THP-COP (pirarubicin 50 mg/m² day 1, cyclophosphamide 750 mg/m² day 1, vincristine 1.4 mg/m² day 1, and prednisolone 100 mg day 1-5) or R-CHOP (adriamicin 50 mg/m² day 1, cyclophosphamide 750 mg/m² day 1, vincristine 1.4 mg/m² day 1, and prednisolone 100 mg day 1-5). The doses of chemotherapeutic agents were adjusted depending on the patient's age and associated complications. The treatment was performed for 6 to 8 cycles. Results Among 74 patients with DLBCL (median 76, range 65-90 years; male 39, female 35), 29 received R-THP-COP, while 45 received R-CHOP. The overall response rates were 94.6% (complete response 86.4%, partial response 8.1%). The 2-year overall and progression-free survival rates were 77.6% and 68.5% for the R-THP-COP regimen and 79.2% and 78.9% for R-CHOP, respectively. No significant differences were found between these two regimens regarding the clinical efficacies. The most frequent adverse event was neutropenia (72.4% for the R-THP-COP regimen, 88.9% for the R-CHOP regimen). The cardiac function as evaluated by ejection fraction values was not impaired in either regimen. Conclusion R-THP-COP was effective and safe as an alternative to R-CHOP.

Keywords: R-CHOP; R-THP-COP; diffuse large B cell lymphoma; old patients; pirarubicin.

Figure 1.

The mean values of the performance status (A), age (B), and Charlson Comorbidity Index (CCI) (C) with each regimen.

Figure 2.

The relative dose intensity of each regimen.

Figure 3.

The overall survival (OS) was calculated from the day of the diagnosis until death or last follow-up. The progression-free survival (PFS) was calculated from the day of the diagnosis until the disease progression or death. The survival durations were estimated by the Kaplan-Meier method. (A) The OS curve. (B) The PFS curve.

Figure 4.

The overall survival (OS) was calculated from the day of the diagnosis until death or last follow-up. The survival durations were estimated by the Kaplan-Meier method. (A) RDI≥70%, the patients who received R-CHOP or R-THP-COP with RDI≥70%; RDI<70%, the patients who received R-CHOP or R-THP-COP with RDI<70%. (B) RDI≥70%, the patients who received R-THP-COP with RDI≥70%; RDI<70%, the patients who received R-THP-COP with RDI<70%.

Figure 5.

The mean neutropenia grades for the R-THP-COP and R-CHOP regimens.

Figure 6.

The ejection fraction values determined in patients before the initiation of chemotherapy and after the completion of treatment. (A) The ejection fraction values at baseline in 14 patients treated with R-THP-COP and 23 patients treated with R-CHOP. (B) The ejection fraction values (median, range) at baseline and after treatment.