Inferior outcomes with R-CEOP for patients with diffuse large B-cell lymphoma and cardiovascular comorbidities

Abstract

Anthracycline-based chemoimmunotherapy with R-CHOP is the standard treatment for diffuse large B-cell lymphoma (DLBCL) but is associated with increased risks of cardiotoxicity. The alternative regimen R-CEOP substitutes etoposide for doxorubicin and is commonly administered to DLBCL patients with cardiovascular comorbidities, although there is limited evidence supporting its use. This multicenter real-world study included 138 consecutive patients with newly-diagnosed DLBCL treated with R-CEOP and 414 patients treated with R-CHOP matched 1:3 for age and International Prognostic Index. With median follow-up time 4.6 years, R-CEOP was associated with significantly inferior 4-year progression-free survival (32 vs. 52%, p < 0.0001), overall survival (39 vs. 59%, p < 0.0001), and disease-specific survival (48 vs. 69%, p < 0.0001) compared to R-CHOP. R-CHOP should remain the preferred regimen for most patients with DLBCL. While R-CEOP may be a reasonable choice for patients strictly ineligible for anthracyclines, the inferior outcomes of this regimen suggest that this high-risk population requires novel therapeutic approaches.

Keywords:

• Diffuse large B-cell lymphoma
• chemotherapy
• comorbidities
• cardiovascular disease

Acknowledgements

The authors thank the physicians and allied health professionals at the Tom Baker Cancer Centre and Cross Cancer Institute for the excellent care they provided these patients.

Ethics approval statement

The study protocol was submitted to the Health Research Ethics Board of Alberta (HREBA), which determined that research ethics approval and informed consent were not required for this retrospective quality assurance study as it poses minimal risk to participants.

Patient consent statement

Consent is not required for this type of retrospective study as it poses minimal risk to participants.

Permission to reproduce material

This study does not include material from other sources.

Clinical trial registration

Not applicable.

Disclosure statement

RP, SG, and AP have no conflicts of interest to disclose. DS has received honoraria for ad hoc advisory boards from Roche, Janssen, Abbvie, Gilead, Celgene, Novartis, AstraZeneca, Amgen, Sandoz, and Teva.

Data availability statement

Data available on request from the authors pending approval of the Health Research Ethics Boards of Alberta and Alberta Health Services.

Additional information

Funding

This study received no funding from any source.