The squeeze.

Top Line: Rituximab has been a total game changer in the treatment of diffuse large B-cell lymphoma (DLBCL), so maybe we should squeeze it for more.
The Study: In HOVON-84, 574 patients with DLBCL planning to receive 6 or 8 cycles of R-CHOP and were randomized to receive rituximab intensification during the first 4 cycles. The trial used a base R-CHOP-14 regimen meaning treatment was given on 14-day cycles. In the intensified RR-CHOP arm, an additional dose of rituximab was administered on day 8 (the off week) of each cycle. Unfortunately, RR-CHOP did not improve the rate of complete remission following induction therapy: 86% with RR versus 89% with R. In addition, at 3 years, there was no improvement in failure-free survival (69% versus 74%, respectively), progression-free survival (71% versus 74%), or overall survival (76% vs 81%). What did RR-CHOP significantly increase? Toxicity, particularly among older patients.
TBL: Upfront intensified dosing of rituximab for DLBCL doesn’t improve clinical outcomes but does worsen toxicity. | Lugtenburg, J Clin Oncol 2020

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