Written in Blood
Is Radiotherapy Necessary for Treating DLBCL With R-CHOP?
The combination of involved-field radiotherapy (RT) and
chemotherapy has been considered a standard treat-
ment for patients with early-stage diffuse large B-cell
lymphoma (DLCBL), but results from a phase III trial
published in Blood challenge the value of RT for this
patient population, suggesting that R-CHOP (rituximab,
cyclophosphamide, doxorubicin, vincristine, prednisone)
alone is non-inferior to R-CHOP plus RT.
“This first randomized study in the rituximab era reports
a similar outcome with these two options in [patients with
non-bulky, early-stage DLBCL],” Thierry Lamy, MD,
PhD, from the Department of Hematology at the Hôpital
Pontchaillou in Rennes, France, and co-authors wrote. “With
more than five years’ follow-up, event-free survival and overall
survival are indeed identical between the two arms.”
The researchers enrolled 334 patients (range = 18-75
years) from 42 French institutions between May 2005 and
June 2014 to determine differences in event-free survival
(EFS) from randomization. All patients had previously
untreated, non-bulky (defined as a tumor <7 cm in diam-
eter), Ann Arbor stage II or II limited DLBCL. Patients
were excluded if they had transformation of a previously
indolent lymphoma, primary cerebral lymphoma, kidney
or liver failure, or contraindication to doxorubicin.
Patients were randomized according to Miller modi-
fied International Prognostic Index (mIPI), lactate de-
hydrogenase (LDH) levels (normal vs. elevated), Eastern