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Association of reduced relative dose intensity and survival in lymphoma patients receiving CHOP-21 chemotherapy

Authors
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SPRINGER
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Disciplines
  • Medicine

Abstract

LETTER TO THE EDITOR Association of reduced relative dose intensity and survival in lymphoma patients receiving CHOP-21 chemotherapy R. Pettengell & M. Schwenkglenks & A. Bosly Received: 7 November 2007 /Accepted: 17 January 2008 /Published online: 26 February 2008 # The Author(s) 2008 Dear Editor, Reductions in average relative chemotherapy dose intensity (ARDI; i.e. administered compared with planned) compro- mise patient outcomes [3], and a recent Belgian study showed that survival for non-Hodgkin lymphoma (NHL) patients receiving CHOP-21 was reduced when ARDI fell below 90% [2]. We support these findings with similar data from the UK Audit of Lymphoma Patients (n=78 patients who received CHOP-21 chemotherapy in 1999–2000) and from the combined Belgian and UK data (n=289) [4]. Patient, disease and treatment characteristics were similar between the two studies, except that the UK patients were younger (mean age ± SD was 55±15 years versus 63± 14 years) and fewer UK patients received colony stimulating factor (CSF). First cycle CSF use was 4% in the UK study compared to 25% in the Belgian study. During an average time to death or censoring of 72 months, 35% of patients in the UK study died. In the Belgian study, the average observation time was 30 months, during which 31% of patients died. After adjusting for the higher mean age of the Belgian patients, Kaplan–Meier survival functions were similar between the two populations (log-rank test stratified by 10-year age groups, p=0.38). Kaplan–Meier plots for patients with >90% ARDI versus ≤90% ARDI showed reduced survival for the patients with ≤90% ARDI (Fig. 1). A trend towards reduced survival was apparent in the UK dataset alone (Fig. 1a; log-rank test- based p=0.090). For the combined dataset, the effect was statistically significant (p<0.001; Fig. 1b), as for the Belgian data alone [2]. Potential predictors of reduced survival were assessed using an extended Cox proportional hazards regression model with robust standard error

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