Shorter Chemotherapy Course Feasible For Younger DLBCL Patients

Reducing CHOP chemotherapy to four cycles does not reduce efficacy for younger patients with favourable-prognosis diffuse large B-cell lymphoma

medwireNews: Results from the FLYER trial of younger patients with low-risk diffuse large B-cell lymphoma (DLBCL) show that four cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy supplemented with rituximab offers equal survival outcomes to a six-cycle CHOP regimen. 

The study findings were presented at the 60th American Society of Hematology Annual Meeting in San Diego, California, USA, by Viola Poeschel, from Saarland University Medical School in Homburg/Saar, Germany. 

Finding the shorter regimen to be non-inferior to the standard chemotherapy protocol, the researchers believe that “chemotherapy can be spared without compromising prognosis in this population.” 

The trial included 592 patients from Germany, Denmark, Norway, Italy and Israel who were aged 18 to 60 years old and had a favourable diagnosis of stage I or II disease less than 7.5 cm in diameter. The participants were followed up for a median of 66 months. 

The primary endpoint of progression-free survival at 36 months was achieved by 94% of the 295 patients who were randomly assigned to receive six 21-day cycles of CHOP chemotherapy plus rituximab and a comparable 96% of the 293 patients who instead were given four 21-day cycles of CHOP plus six cycles of rituximab. 

And there was no significant difference between the six-cycle and four-cycle treatment arms with regard to overall survival, with 98% and 99% of patients, respectively, alive at 36 months. 

Patients given four cycles of CHOP sustained fewer haematological adverse events than those given six cycles, including leukocytopenia at any-grade (171 vs 297) and grade 3–4 (80 vs 171), and any-grade anemia (107 vs 172), but had comparable rates of grade 3–4 anaemia and thrombocytopenia at any severity and at grade 3–4.   

There were a total of 1295 any-grade and 70 grade 3–4 non-haematological events reported among the patients who received six cycles of CHOP compared with a corresponding 835 and 46 events among those given four cycles, translating to an event reduction of around one-third. 

This was true for the most common adverse events of paresthesia, nausea, infection, vomiting and mucositis, and translates to “an important and meaningful benefit to patients”, Viola Poeschel commented. 

She concluded: “We think this will be the new standard of treatment for this patient population.” 



Poeschel V, Held G, Ziepert M, et al. Excellent Outcome of Young Patients (18-60 years) with Favourable-Prognosis Diffuse Large B-Cell Lymphoma (DLBCL) Treated with 4 Cycles CHOP Plus 6 Applications of Rituximab: Results of the 592 Patients of the Flyer Trial of the Dshnhl /GLA . Blood 2018 132:781; doi:

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