Key result
In older patients with diffuse large B-cell lymphoma, treatment with R-COMP yielded a 3-year progression-free survival of 64% compared to 70% with R-CHOP, with similar rates of cardiac events.
Why the study?
R-CHOP is associated with cardiotoxicity in older DLBCL patients, and while substituting doxorubicin with non-PEGylated liposomal doxorubicin (R-COMP) may reduce cardiac risk, its efficacy had not been demonstrated in prospective trials.
Does R-COMP compared to R-CHOP maintain efficacy and reduce cardiac events in older patients with diffuse large B-cell lymphoma?
Cohort (n=1,163)
Yes
Does R-COMP compared to R-CHOP maintain efficacy and reduce cardiac events in older patients with diffuse large B-cell lymphoma?
R-COMP provides similar progression-free survival and overall survival to R-CHOP in older DLBCL patients, representing a potentially curative option for those with intermediate- or high-risk disease and baseline cardiopathy.
R-COMP may be considered for older DLBCL patients with cardiac risk; leaves open cardiac benefit versus R-CHOP in randomized trials.
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the most commonly used regimen for the upfront treatment of diffuse large B-cell lymphoma (DLBCL). However, it is associated with cardiotoxicity, especially in older patients. Substituting doxorubicin with non-PEGylated liposomal doxorubicin (R-COMP) may reduce the risk of cardiac events, but its efficacy has never been demonstrated in prospective trials. We describe the characteristics and outcome of patients with DLBCL aged ≥65 years prospectively enrolled in the Elderly Project by the Fondazione Italiana Linfomi and treated with full doses of R-CHOP or R-COMP per local practice. Starting from 1163 patients, 383 (55%) were treated with R-CHOP and 308 (45%) with R-COMP. Patients treated with R-COMP were older (median age, 76 vs 71 years), less frequently fit at simplified geriatric assessment (61% vs 88%; P < .001), and had a more frequent baseline cardiac disorders (grade >1, 32% vs 8%; P < .001). Three-year progression-free survival (PFS) was similar between R-CHOP and R-COMP (70% and 64%); 3-year overall survival was 77%, and 71% respectively. R-CHOP was associated with better PFS vs R-COMP only in the Elderly Prognostic Index (EPI) low-risk group. The two groups had similar rates of treatment interruptions due to toxicities or of cardiac events (P = 1.00). We suggest R-COMP is a potentially curative treatment for older patients with intermediate- or high-risk EPI, even in the presence of a baseline cardiopathy. R-CHOP is confirmed as the standard therapy for low risk patients.
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Arcari et al. (2023) conducted a cohort in Diffuse large B-cell lymphoma (DLBCL) (n=1,163). R-COMP vs. R-CHOP was evaluated on 3-year progression-free survival (PFS). In older patients with diffuse large B-cell lymphoma, treatment with R-COMP yielded a 3-year progression-free survival of 64% compared to 70% with R-CHOP, with similar rates of cardiac events.
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