Respect of Average Relative Dose Intensity Correlates with Survival in Diffuse Large B Cell Lymphoma Patients Treated by CHOP: A National Retrospective Study (1995–2000).

Aims: To describe the different regimens of chemotherapy (CT), the average relative dose (ARD) and dose-intensity (ARDI) for first line treatment of patients (pts) with diffuse large B-cell lymphoma (DLBCL).

Methods: 373 adult patients files from 29 centers receiving at least 3 cycles of treatment for DLBCL, included or not in a protocol between 1995 and 2000, were retrospectively reviewed. ARD and ARDI analysis (delivered vs planned) was only performed for cyclophosphamide (C) and anthracyclines (A) as they are considered to be the most important agents.

Results: 348 pts treated with CHOP-like, ACVBP-like or CHVmP-BV were evaluable for the analysis. CHOP-like was the most commonly used regimen (273 pts, 79 %) of which CHOP-21 (210 pts) was the most frequent; followed by ACVBP (57 pts, 16 %) (with ACVBP-14 (46 pts) as the most important type) and CHVmP-BV (18 pts, 5 %). For all regimens the relative total dose (RTD) effectively received was 96 % for C and 94 % for A, respectively, and the relative total dose intensity (RTDI) scored 92 % for C and 90 % for A. This results in an ARD of 94 % (SD 14 %) for CHOP, 99 % (SD 4 %) for ACVBP and 95 % (SD 16 %) for CHVmP-BV and an ARDI of 92 % (SD 13 %) for CHOP, 88 % (SD 13 %) for ACVBP and 91 % (SD 16 %) for CHVmP-BV, respectively. 10 % of the pts dit not receive an ARD > 80 % (CHOP: 12 %, ACVBP: 2 % and CHVmP-BV: 6 %) and 16.5 % of pts had an ARDI below 80 % (CHOP: 15 %, ACVBP: 26 % and CHVmP-BV: 11 %). Overall, 45 % of the pts had dose modifications (dose delays (DD), dose reductions (DR) or both). Hematological toxicity was the major reason for CT-adjustment. In total, 56 % of pts received granulocyte colony-stimulating factor (G-CSF) treatment (CHOP: 47 %, ACVBP: 100 %, CHVmP-BV: 61 %). The different regimens used having a very different dose-intensity, analysis of effect of ARDI on survival was restricted to the 210 patients treated with CHOP-21. Mean overall survival of these patients according to ARDI category (> 90 %, £ 90 %) was respectively (mean ± SD) 5.38 y ± 0.58 and 2.24 y ± 0.30. Cox regression for effect of ARDI on overall survival was significant (p = 0.002).

Conclusions: (1) With respect to dose-intensity, lymphoma pts treated in hematological departments in Belgium benefit from optimal treatment. (2) CHOP-21 is the most frequently used CT regimen, followed by ACVBP and CHVmP-BV. (3) In pts treated with CHOP-21, overall survival was significantly improved when ARDI was superior to 90 %.