R‐miniCHOP versus R‐CHOP in elderly patients with diffuse large B‐cell lymphoma: A propensity matched population‐based study

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Abstract
For elderly frail patients with diffuse large B‐cell lymphoma (DLBCL), an attenuated chemo‐immunotherapy strategy of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R‐miniCHOP) was introduced as a treatment option as from 2014 onward in the Netherlands. Although R‐miniCHOP is more tolerable, reduction of chemotherapy could negatively affect survival compared to R‐CHOP. The aim of this analysis was to assess survival of patients treated with R‐miniCHOP compared to R‐CHOP. DLBCL patients ≥65 years, newly diagnosed in 2014–2020, who received ≥1 cycle of R‐miniCHOP or R‐CHOP were identified in the Netherlands Cancer Registry, with survival follow‐up through 2022. Patients were propensity‐score‐matched for baseline characteristics. Main endpoints were progression‐free survival (PFS), overall survival (OS), and relative survival (RS). The use of R‐miniCHOP in DLBCL increased from 2% in 2014 to 15% in 2020. In total, 384 patients treated with R‐miniCHOP and 384 patients treated with R‐CHOP were included for comparison (median age; 81 years, stage 3–4; 68%). The median number of R‐(mini)CHOP cycles was 6 (range, 1–8). The 2‐year PFS, OS and RS were inferior for patients treated with R‐miniCHOP compared to R‐CHOP (PFS 51% vs. 68%, p < .01; OS 60% vs. 75%, p < .01; RS 69% vs. 86%, p < .01). In multivariable analysis, patients treated with R‐miniCHOP had higher risk of all‐cause mortality compared to patients treated with R‐CHOP (HR 1.73; 95%CI, 1.39–2.17). R‐miniCHOP is effective for most elderly patients. Although survival is inferior compared to R‐CHOP, the use of R‐miniCHOP as initial treatment is increasing. Therefore, fitness needs to be carefully weighed in treatment selection.

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