Impact of vincristine dose reduction on overall survival in patients with DLBCL

Abstract

Introduction: The standard first-line treatment for diffuse large B-cel lymphoma (DLBCL), an aggressive non-hodgkin lymphoma, is the R-CHOP regimen: a combination of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. The most common adverse effect of this regime is neurotoxicity caused by vincristine. For this reason vincristine is frequently reduced or omitted from the therapy. Methods: In this retrospective cohort study medical records from patients with de novo DLBCL, diagnosed between 2015 and 2021, were reviewed. The objective was to investigate the effect of vincristine dose reduction on overall survival and progression free survival in DLBCL patients treated with R-CHOP. Patients were included if they had completed at least six courses of chemotherapy. Survival status was obtained through the personal records database. Results: In total 101 patients were included in our analysis. Vincristine was reduced or omitted in 49/101 patients. The overall survival of all patients was high, 88%. Vincristine reduction did not affect progression free survival or overall survival in our cohort. Relative dose intensity <85% produced a hazard ratio of 0.359 (95% confidence interval 0.097-1.325). In univariate analysis only age was associated with poorer survival. Discussion: Even though our study was potentially underpowered, we did not find a difference in progression free survival or in overall survival in DLBCL patients with and without reduction of vincristine from the R-CHOP regimen.