Treatment related toxicity during the treatment of Diffuse large B cell lymphoma (DLBCL) is highest during the initial phase of treatment (First cycle effect). The toxicity can be febrile neutropenia, tumour lysis syndrome, deterioration in performance status and death. Introduction of prephase treatment is popular method to reduce this toxicity. This study was undertaken to evaluate the benefit of prephase treatment in Indian patients.
This was a prospective study carried out at Kidwai memorial institute of oncology Bangalore, India from July 2015 to December 2016. The newly diagnosed patients of DLBCL, age>18years, stage II-IV were enrolled in study. Written consent taken from all patients before starting chemotherapy (CHOP/R-CHOP). Out of 50 patients, 25 patients received prephase treatment consisting of vincristine (1 mg) on -6th days and prednisone 100 mg daily for 7 day (-6 day to day 0). All patients received CHOP/R-CHOP chemotherapy on day 1. ECOG performance status, nadir absolute neutrophil count (ANC) on day 10, febrile neutropenia, and hospitalization, requirement of antibiotics and mortality within 30 days of chemotherapy were compared in both the groups. Patients above 60 years received prophylactic growth factor.
The median age of the patients were as 50.5 years (Range 20-74 years). Thirty patients were male and twenty patients were female. Twenty patients (40%) had stage 2 disease while the other 60% patients had stage 3 or stage 4 disease. Most of the patients (96%) attanined ECOG performance status of 0 or 1 after prephase treatment. The incidence of any grade neutropenia on D10 of chemotherapy in experimental arm was 44% (88% in control arm) while the grade 3/4 neutropenia was 12% (48% in control arm). Febrile neutropenia in the experimental arm was lower (12%) as compared to control arm (32%) (p value
Prephase treatment significantly improves the performance status of DLBCL patients prior to receiving chemotherapy (CHOP±Rituximab). First cycle effect, including decrease chances of febrile neutropenia and improvement in nadir ANC are impressive benefits of prephase treatment.
Clinical trial identification
Legal entity responsible for the study
Kidawai memorial institute of oncology Bengaluru India
All authors have declared no conflicts of interest.