Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma
Diffuse large B-cell lymphoma (DLBCL) and osteoporotic fracture are both more common in older patients. Exposure to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is likely to increase the risk of fracture, but evidence is lacking to define fracture incidence in thi...
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creator | Booth, Stephen Plaschkes, Hannah Kirkwood, Amy A. Gibb, Adam Horgan, Patrick Higham, Claire Oladipo, Joanna M. Browning, Joe Khan, Usman Tseu, Bing Chen, Lucia Willan, John Wolf, Julia Gunawan, Arief Fields, Paul Ebsworth, Tim Lown, Robert Gordon-Walker, Dominic Shah, Nimish Linton, Kim M. Collins, Graham P. Kothari, Jaimal Hildyard, Catherine Eyre, Toby A. |
description | Diffuse large B-cell lymphoma (DLBCL) and osteoporotic fracture are both more common in older patients. Exposure to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is likely to increase the risk of fracture, but evidence is lacking to define fracture incidence in this group. Data on consecutive patients with DLBCL aged ≥70 years treated with 1 to 8 cycles of full or attenuated R-CHOP were retrospectively collected across 10 UK centers (2009-2019). Patients were followed up from starting R-CHOP for a minimum of 6 months and censored at 18 months; at last follow-up if |
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•Cumulative fracture incidence after R-CHOP in older patients (>70 years) is high (11.4% at 18 months).•Bone involvement, prephase steroids, or either reduced bone mineral density, RhA, or prior fracture are independent risk factors.
[Display omitted]</description><identifier>ISSN: 2473-9529</identifier><identifier>EISSN: 2473-9537</identifier><identifier>DOI: 10.1182/bloodadvances.2020002553</identifier><identifier>PMID: 32915975</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Cyclophosphamide - adverse effects ; Doxorubicin - adverse effects ; Humans ; Lymphoid Neoplasia ; Lymphoma, Large B-Cell, Diffuse - drug therapy ; Lymphoma, Large B-Cell, Diffuse - epidemiology ; Retrospective Studies ; Rituximab - adverse effects ; Vincristine - adverse effects</subject><ispartof>Blood advances, 2020-09, Vol.4 (18), p.4337-4346</ispartof><rights>2020 American Society of Hematology</rights><rights>2020 by The American Society of Hematology.</rights><rights>2020 by The American Society of Hematology 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-551c7557308fafa9c999673620e49ead15c14e30cad396e4ffe95baf27959b5c3</citedby><cites>FETCH-LOGICAL-c479t-551c7557308fafa9c999673620e49ead15c14e30cad396e4ffe95baf27959b5c3</cites><orcidid>0000-0002-6631-9749 ; 0000-0002-3294-1548 ; 0000-0003-2687-0234</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509870/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509870/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32915975$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Booth, Stephen</creatorcontrib><creatorcontrib>Plaschkes, Hannah</creatorcontrib><creatorcontrib>Kirkwood, Amy A.</creatorcontrib><creatorcontrib>Gibb, Adam</creatorcontrib><creatorcontrib>Horgan, Patrick</creatorcontrib><creatorcontrib>Higham, Claire</creatorcontrib><creatorcontrib>Oladipo, Joanna M.</creatorcontrib><creatorcontrib>Browning, Joe</creatorcontrib><creatorcontrib>Khan, Usman</creatorcontrib><creatorcontrib>Tseu, Bing</creatorcontrib><creatorcontrib>Chen, Lucia</creatorcontrib><creatorcontrib>Willan, John</creatorcontrib><creatorcontrib>Wolf, Julia</creatorcontrib><creatorcontrib>Gunawan, Arief</creatorcontrib><creatorcontrib>Fields, Paul</creatorcontrib><creatorcontrib>Ebsworth, Tim</creatorcontrib><creatorcontrib>Lown, Robert</creatorcontrib><creatorcontrib>Gordon-Walker, Dominic</creatorcontrib><creatorcontrib>Shah, Nimish</creatorcontrib><creatorcontrib>Linton, Kim M.</creatorcontrib><creatorcontrib>Collins, Graham P.</creatorcontrib><creatorcontrib>Kothari, Jaimal</creatorcontrib><creatorcontrib>Hildyard, Catherine</creatorcontrib><creatorcontrib>Eyre, Toby A.</creatorcontrib><title>Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma</title><title>Blood advances</title><addtitle>Blood Adv</addtitle><description>Diffuse large B-cell lymphoma (DLBCL) and osteoporotic fracture are both more common in older patients. Exposure to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is likely to increase the risk of fracture, but evidence is lacking to define fracture incidence in this group. Data on consecutive patients with DLBCL aged ≥70 years treated with 1 to 8 cycles of full or attenuated R-CHOP were retrospectively collected across 10 UK centers (2009-2019). Patients were followed up from starting R-CHOP for a minimum of 6 months and censored at 18 months; at last follow-up if <18 months; or at progression or death. Of 877 patients identified, 148 were excluded: 121 had progression or died before 6 months; 23 had follow-up <6 months. Across 729 remaining patients, the median age was 77 years, and 68% had an Eastern Cooperative Oncology Group performance status of 0 to 1. Eighty-one fractures occurred within 18 months of follow-up; 42 were symptomatic, including 30 requiring hospital attendance or admission. The cumulative fracture incidence was 6.2% (95% confidence interval [CI], 4.7-8.2) at 6 months; 9.7% (95% CI, 7.8-12.1) at 12 months; and 11.4% (95% CI, 9.3-14.0) at 18 months. Multivariate analysis identified a predisposing history (osteoporosis, osteopenia, prior fracture, and rheumatoid arthritis [RhA]), DLBCL bone involvement at baseline, and receipt of prephase steroids as independent risk factors for fracture. There is a clinically relevant fracture risk and significant associated morbidity in older patients receiving R-CHOP. Careful attention to bone health is warranted in older patients receiving R-CHOP. Randomized studies are required to better define the most effective strategies to reduce fracture risk.
•Cumulative fracture incidence after R-CHOP in older patients (>70 years) is high (11.4% at 18 months).•Bone involvement, prephase steroids, or either reduced bone mineral density, RhA, or prior fracture are independent risk factors.
[Display omitted]</description><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Cyclophosphamide - adverse effects</subject><subject>Doxorubicin - adverse effects</subject><subject>Humans</subject><subject>Lymphoid Neoplasia</subject><subject>Lymphoma, Large B-Cell, Diffuse - drug therapy</subject><subject>Lymphoma, Large B-Cell, Diffuse - epidemiology</subject><subject>Retrospective Studies</subject><subject>Rituximab - adverse effects</subject><subject>Vincristine - adverse effects</subject><issn>2473-9529</issn><issn>2473-9537</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV9vFCEUxYnR2Kb2KxgefZnKn2EZXkzsxlqTJjVGnwkLl10MM6zAbNNvX9Ztt_bJJyD3d8693IMQpuSC0oF9XMWUnHE7M1koF4wwQggTgr9Cp6yXvFOCy9fHO1Mn6LyU3w2icsGFYm_RCWeKCiXFKdpdZWPrnKFgkwHbNI5pwnehbsKE6YDbq24K9inGdBemNfYhl9rFMAH-0S2vb7_jBqboIOOtqQGmWv7KsQvezwVwNHkN-LKzECOO9-N2k0bzDr3xJhY4fzzP0K-rLz-X193N7ddvy883ne2lqp0Q1EohJCeDN94oq5RaSL5gBHoFxlFhaQ-cWOO4WkDvPSixMp5JJdRKWH6GPh18t_NqBGfbeNlEvc1hNPleJxP0y8oUNnqddloKogZJmsGHR4Oc_sxQqh5D2X_FTJDmolnfM0aU4nt0OKA2p1Iy-GMbSvQ-Of0iOf2cXJO-_3fMo_AppwZcHgBoy9oFyLrYtmsLLmSwVbsU_t_lAQDusbA</recordid><startdate>20200922</startdate><enddate>20200922</enddate><creator>Booth, Stephen</creator><creator>Plaschkes, Hannah</creator><creator>Kirkwood, Amy A.</creator><creator>Gibb, Adam</creator><creator>Horgan, Patrick</creator><creator>Higham, Claire</creator><creator>Oladipo, Joanna M.</creator><creator>Browning, Joe</creator><creator>Khan, Usman</creator><creator>Tseu, Bing</creator><creator>Chen, Lucia</creator><creator>Willan, John</creator><creator>Wolf, Julia</creator><creator>Gunawan, Arief</creator><creator>Fields, Paul</creator><creator>Ebsworth, Tim</creator><creator>Lown, Robert</creator><creator>Gordon-Walker, Dominic</creator><creator>Shah, Nimish</creator><creator>Linton, Kim M.</creator><creator>Collins, Graham P.</creator><creator>Kothari, Jaimal</creator><creator>Hildyard, Catherine</creator><creator>Eyre, Toby A.</creator><general>Elsevier Inc</general><general>American Society of Hematology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6631-9749</orcidid><orcidid>https://orcid.org/0000-0002-3294-1548</orcidid><orcidid>https://orcid.org/0000-0003-2687-0234</orcidid></search><sort><creationdate>20200922</creationdate><title>Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma</title><author>Booth, Stephen ; 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Exposure to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is likely to increase the risk of fracture, but evidence is lacking to define fracture incidence in this group. Data on consecutive patients with DLBCL aged ≥70 years treated with 1 to 8 cycles of full or attenuated R-CHOP were retrospectively collected across 10 UK centers (2009-2019). Patients were followed up from starting R-CHOP for a minimum of 6 months and censored at 18 months; at last follow-up if <18 months; or at progression or death. Of 877 patients identified, 148 were excluded: 121 had progression or died before 6 months; 23 had follow-up <6 months. Across 729 remaining patients, the median age was 77 years, and 68% had an Eastern Cooperative Oncology Group performance status of 0 to 1. Eighty-one fractures occurred within 18 months of follow-up; 42 were symptomatic, including 30 requiring hospital attendance or admission. The cumulative fracture incidence was 6.2% (95% confidence interval [CI], 4.7-8.2) at 6 months; 9.7% (95% CI, 7.8-12.1) at 12 months; and 11.4% (95% CI, 9.3-14.0) at 18 months. Multivariate analysis identified a predisposing history (osteoporosis, osteopenia, prior fracture, and rheumatoid arthritis [RhA]), DLBCL bone involvement at baseline, and receipt of prephase steroids as independent risk factors for fracture. There is a clinically relevant fracture risk and significant associated morbidity in older patients receiving R-CHOP. Careful attention to bone health is warranted in older patients receiving R-CHOP. Randomized studies are required to better define the most effective strategies to reduce fracture risk.
•Cumulative fracture incidence after R-CHOP in older patients (>70 years) is high (11.4% at 18 months).•Bone involvement, prephase steroids, or either reduced bone mineral density, RhA, or prior fracture are independent risk factors.
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subjects | Aged Antineoplastic Combined Chemotherapy Protocols - adverse effects Cyclophosphamide - adverse effects Doxorubicin - adverse effects Humans Lymphoid Neoplasia Lymphoma, Large B-Cell, Diffuse - drug therapy Lymphoma, Large B-Cell, Diffuse - epidemiology Retrospective Studies Rituximab - adverse effects Vincristine - adverse effects |
title | Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma |
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