Utilization and tolerability of R-CHOP and R-mini–CHOP in patients with diffuse large B-cell lymphoma (DLBCL) at a community cancer center

Abstract

Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, accounting for approximately 25–30% of cases. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard therapy for patients diagnosed with DLBCL. This therapy can be more difficult to tolerate in older patients; therefore, the regimen R-mini–CHOP was added as a treatment option in 2014 for patients 80 years and older with comorbidities. While there have been studies published in relation to R-CHOP versus R-mini–CHOP in academic settings, there have been limited studies on R-mini–CHOP utilization in a community setting. Methods A retrospective chart review was conducted of 50 patients diagnosed with DLBCL at Bayhealth Cancer Center between 2018 and 2022. Patients were categorized based on treatment received: R-CHOP (n=34), R-mini–CHOP (n=4), and no systemic treatment (n=12). The study looked at the completion of treatment, incidence of relapse, hospitalization rates, treatment delays, episodes of febrile neutropenia, and cardiac complications. Results: Among the 34 R-CHOP, 30 (88%) completed therapy versus 3 of 4 (75%) R-mini–CHOP group and 3 of 12 (25%) untreated group. Most patients were White (40/50, 80%), with a median age of 70.1 years. Comorbidities were present in 41 patients (84%), and 14 (28%) had more than three. An ECOG performance status of 0–1 was documented in 40 patients (81%). Among the 6 patients aged over 80, two received R-CHOP, one received R-mini–CHOP, and 3 had no treatment. Relapse was observed in 10 of 34 (29%) R-CHOP recipients, 1 of 4 (25%) R-mini–CHOP, and 2 of 6 (33%) untreated patients with available follow-up; 6 of 12 (50%) in the no-treatment group were lost to follow-up. Of those who relapsed after R-CHOP, 7 of 10 (70%) did so within 3 months. Treatment-related hospitalization occurred in 9 of 34 (26%) R-CHOP patients and none receiving R-mini–CHOP. Febrile neutropenia occurred in 5 of 34 (15%) R-CHOP patients and none in the R-mini–CHOP group. Cardiac toxicity was observed in 1 R-CHOP patient (3%).Conclusions: R-CHOP was associated with high treatment completion and with toxicity, however there was no statistical significance in toxicities or relapse rates noted when compared to R-mini-CHOP. The underutilization of R-mini-CHOP along with significant loss to follow-up in the untreated group limited comparative assessment. These findings underscore the need for quality initiatives to expand appropriate use of R-mini-CHOP and strengthen longitudinal follow-up in community oncology settings. Lastly, the question for consideration is, should mini-R CHOP become the treatment of choice in patients over age 60 with co-morbidities?