I have been diagnosed with mediastinal B-cell non Hodgkins lymphoma. Both specialists I saw recommended the same chemo regimen (R-CHOP) for 6-8 cycles but one of them prefers to give the R at the end of the 6-8 cycles. Is this common and if yes what are the benefits?
Hi. The original R-CHOP regimen described by Coiffier, et. al. in 2002 has Rituximab (R) being given on Day 1 of the regimen, together with the cytotoxic drugs (CHOP). The addition of Rituximab to CHOP in this manner increases the complete response rate (76% [R-CHOP] vs. 63% [CHOP]). R-CHOP also increases the "three year failure -free survival rate (FFS)" to 53%, from 46% for CHOP. Three year FFS refers to the percent of patients surviving for three years without disease recurrence or disease progression.
Rituximab may be given after finishing all cycles of CHOP (called "maintenance Rituximab" or MR), and this also has advantages over plain CHOP, but the benefits do not exceed those that can be obtained by giving Rituximab up front with CHOP (R-CHOP). The study by Habermann, et. al. in 2006 compared patients with diffuse B-cell Non-Hodgkins Lymphoma given either R-CHOP, CHOP, R-CHOP plus MR and CHOP plus MR. The two year failure free survival rate were as follows:
R-CHOP - 77%
R-CHOP plus MR - 79%
CHOP plus MR - 74%
CHOP alone - 45%
So there may be a slight advantage in two-year FFS in favor of R-CHOP over CHOP-MR (77% vs 74%). The 2 percent difference between the FFS of R-CHOP and R-CHOP+MR is not statistically significant.
In summary, it makes little difference whether Rituximab is given initially with CHOP or after all cycles of CHOP are finished. What matters is for Rituximab to be added to the regimen.
Copyright 1994-2016 MedHelp International. All rights reserved.
MedHelp is a division of Aptus Health.
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.