R-split-CHOP chemotherapy for elderly patients with diffuse large B-cell lymphoma

OBJECTIVES: Chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, prednisolone and rituximab (R-CHOP) is the standard of care for patients with diffuse large B-cell lymphoma (DLBCL). However, management of elderly patients is challenging as critical comorbidities often account for increased number of treatment related complications. PATIENTS AND METHODS: In the past 8 years, we have treated elderly patients with a full-dose R-CHOP regimen by splitting the administration of cyclophosphamide and doxorubicin over two days (R-split-CHOP) to reduce peak plasma level. Here, we retrospectively analyzed the results of 30 patients with newly diagnosed DLBCL. RESULTS: The overall response rate was found to be 87%, the overall survival probability after 3 years was 60.6% (95% CI, 42.1%-79.0%), the progression-free survival probability 49.7% (95% CI, 30.4%-68.9%), respectively. Grade 3/4 infectious complications were reported in 30% of patients, yet no treatment-related deaths occurred. CONCLUSION: We suggest that R-split-CHOP could be a valuable option to safely administer full-dose intensity R-CHOP to elderly patients at risk of treatment-related complications