Efficacy and safety of substitute vincristine with vindesine in R-CHOP- like regimen in the treatment of newly diagnosed DLBCL, a real-world study

Background The replacement of doxorubicin with other anthracyclines like epirubicin, pirarubicin, or liposomal adriamycin in the R-CHOP regime showed non-inferiority for DLBCL. Replacing vincristine with vindesine (R-CHVP) in R-CHOP has rarely been compared in efficacy and safety. This study aimed to figure out whether R-CHVP was non-inferior to R-CHOP in both efficacy and toxic effects. Methods This is a retrospective study performed at The First Hospital of Lanzhou University, including all consecutive adult patients aged over 18 years with newly diagnosed DLBCL who received therapy with R-CHOP or R-CHVP from March 2008 to September 2020. We compared the efficacy and safety of the R-CHVP regimen with vincristine and the R-CHOP regimen with vindesine. Results We identified 56 patients with DLBCL, including 18 patients in R-CHOP, 7 in R-CTOP, 12 in R-CEOP, 17 in R-CEVP, 11 in R-CTVP. Complete response was achieved in 12(66.7%), 4(57.1%), 5(41.7%), 7(41.2%) and 4(36.4%) patients respectively. The ORR of the five different schemes is 83.3%, 85.7%, 66.7%，64.07%，and 81.8%, respectively. The most common hematological adverse events during induction were anemia and neutropenia, and the most common non-hematological toxicity are gastrointestinal symptoms and neurotoxicity. The comparison of adverse events between R-CEOP and R-CEVP groups is as follows: the toxicity of hematological adverse events was not statistically significant; among non-hematological toxicity, the R-CEVP group was superior to the R-CEOP group in peripheral neuropathy (p=0.026). The 2-year progression-free survival were 75.5%, 54.6%, 53.2%, 62.7% and 42.4% in R-CHOP, R-CTOP, RCEOP, R-CEVP and R-CTVP group respectively. Conclusion The R-CHVP, in which vincristine was substituted by vindesine, was not inferior to the standard R-CHOP regimen and showed less neurotoxicity. Treatment regimens composed of different anthracyclines have similar therapeutic benefits and adverse events in addition to cardiotoxicity.