Impact of prednisolone dosage in the CHOP regimen for follicular lymphoma: a retrospective study
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ORIGINAL ARTICLE
Impact of prednisolone dosage in the CHOP regimen for follicular lymphoma: a retrospective study Takashi Ikeda1 · Shin‑ichiro Fujiwara1 · HIrotomo Nakajima1 · Shin‑ichiro Kawaguchi1 · Yumiko Toda1 · Shoko Ito1 · Shinichi Ochi1 · Takashi Nagayama1 · Kiyomi Mashima1 · Kento Umino1 · Daisuke Minakata1 · Hirofumi Nakano1 · Kaoru Morita1 · Ryoko Yamasaki1 · Yasufumi Kawasaki1 · Masahiro Ashizawa1 · Chihiro Yamamoto1 · Kaoru Hatano1 · Kazuya Sato1 · Iekuni Oh1 · Ken Ohmine1 · Kazuo Muroi1 · Yoshinobu Kanda1 Received: 6 January 2020 / Revised: 11 May 2020 / Accepted: 29 May 2020 © Japanese Society of Hematology 2020
Abstract Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) is one of the standard regimens for indolent B-cell non-Hodgkin’s lymphoma (NHL). It is unclear whether the prednisolone (PSL) dosage affects the therapeutic effect or the adverse event profile. We retrospectively examined 48 patients with indolent B-cell NHL who were treated with R-CHOP (PSL 50 mg/m2/day for 5 days) at our institute between 2006 and 2016. We compared them with 149 patients with indolent B-cell lymphoma who were treated with R-CHOP (PSL 100 mg for 5 days) in the JCOG 0203 trial. The proportions of patients with bulky disease, extranodal involvement, and increased nodal sites were higher at our institute. Nevertheless, there was no difference in the CR rate, PFS, OS or the frequency of adverse events, except for peripheral neuropathy, between the two treatment groups. In our institute, there was no difference in the CR rate, PFS, OS or adverse event profile between patients who received PSL at 60–80 mg/day and at 81–100 mg/day. Patients who received PSL at 60–80 mg/day included many female and light-weight patients. In conclusion, the PSL dose adjusted based on body surface area appeared to be appropriate in terms of efficacy and safety. Keywords Malignant lymphoma · Chemotherapy · Prednisolone dosage
Introduction Rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is regarded as one of the most effective first-line treatments for indolent B-cell nonHodgkin’s lymphoma (NHL), with a good profile regarding the complete remission (CR) rate, progression-free survival (PFS) and overall survival (OS) [1]. The most common adverse events include neutropenia, vomiting, peripheral neuropathy, and constipation, but the frequency and grade are generally tolerable, and this regimen is considered to be well-balanced in terms of efficacy and safety [1]. Corticosteroids such as prednisone and dexamethasone are an integral part of most regimens against * Yoshinobu Kanda ycanda‑[email protected] 1
Division of Hematology, Department of Medicine, Jichi Medical University, 3311‑1 Yakushiji, Shimotuke, Tochigi 329‑0498, Japan
lymphoproliferative disorders [2–4], but their long-term use is associated with various side effects including diabetes mellitus, hyperlipidemia and osteoporosis. With regard to the CHOP regimen, prednisone is most commonly used at a fixed dose of
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