Safety and Efficacy of Replacing Vindesine with Vincristine in R-ACVBP Regimen for the Treatment of Large B Cell Lymphomas
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Elsevier Inc.
Abstract
Background: Intensified immunochemotherapy with rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP) improves outcomes in younger adults with diffuse large B-cell lymphomas (DLBCL) compared with R-CHOP. Due to vindesine unavailability, we assessed the safety and efficacy of replacing vindesine with vincristine in a modified R-ACVBP protocol (mR-ACVBP). Methods: This is a retrospective study including all consecutive adult patients with newly diagnosed DLBCL who received first-line mR-ACVBP. Vindesine was replaced with vincristine 1.5 mg on days 1 and 5 of each cycle. Responders continued with published R-ACVBP consolidation. Patients with inadequate response on interim imaging were offered consolidative autologous stem cell transplantation. Results: We identified 56 patients with DLBCL, with a median age of 41 years (range, 21-67). Thirty-seven (66%) patients had an age-adjusted International Prognostic Index of ≥ 2. Complete response was achieved in 41 (80%) patients and partial response in 6 (12%). The most common adverse events during induction were anemia (91%), febrile neutropenia (64%; grade 4 in 46%), thrombocytopenia (39%), and mucositis (21%). Peripheral neuropathy was encountered in 7 (12%) patients (grade 3; n = 1). Two deaths from septic shock were reported in patients with initial poor performance status. After a median follow-up of 17 months, the 2-year progression-free survival and overall survival rates were 86% and 87%, respectively. Conclusion: The replacement of vindesine with vincristine in mR-ACVBP seems feasible, with manageable adverse events and excellent 2-year progression-free survival. These data need validation in larger prospective trials. © 2021 Elsevier Inc.
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Dlbcl, High-grade b-cell lymphoma, R-acvbp, Vincristine, Vindesine, Adult, Aged, Antineoplastic combined chemotherapy protocols, Bleomycin, Cyclophosphamide, Doxorubicin, Female, Humans, Lymphoma, large b-cell, diffuse, Male, Middle aged, Prednisone, Retrospective studies, Young adult, Carboplatin, Cisplatin, Cytarabine, Dexamethasone, Etoposide, Filgrastim, Fluconazole, Fluorodeoxyglucose f 18, Granulocyte colony stimulating factor, Ifosfamide, Levofloxacin, Mesna, Methotrexate, Rituximab, Valaciclovir, Antineoplastic agent, Acute kidney failure, Add on therapy, Anemia, Article, Autologous hematopoietic stem cell transplantation, Autologous stem cell transplantation, Bacterial infection, Cancer immunotherapy, Cancer patient, Cancer recurrence, Cancer survival, Central nervous system disease, Clinical outcome, Consolidation chemotherapy, Controlled study, Diffuse large b cell lymphoma, Drug dose increase, Drug dose reduction, Drug efficacy, Drug megadose, Drug safety, Drug substitution, Drug withdrawal, Feasibility study, Febrile neutropenia, Follow up, Gastrointestinal irritation, Headache, Heart disease, High risk patient, Human, Hypertransaminasemia, Infusion related reaction, International prognostic index, Major clinical study, Maximum standardized uptake value, Mortality, Mucosa inflammation, Multiple cycle treatment, Mycosis, Neuropathy, Neutropenia, Overall response rate, Overall survival, Peripheral neuropathy, Pneumonia, Positron emission tomography-computed tomography, Progression free survival, Prospective study, Remission, Retrospective study, Septic shock, Skin toxicity, Thrombocytopenia, Thrombosis, Treatment response, Virus infection, Whole body ct