European journal of cancer (Oxford, England : 1990) · 2025
Non-inferior outcome of abbreviated R-CHOP in patients with stage I primary testicular lymphoma.
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Al-Sarayfi Diana, Bult Johanna A A, de Groen Ruben A L, de Groot Fleur A, Vermaat Joost S P, Issa Djamilla, Diepstra Arjan, Huls Gerwin, Bellido Mar, Plattel Wouter, Brink Mirian, Nijland Marcel
Аннотация
BACKGROUND: Patients with limited-stage primary testicular lymphoma (PTL) typically receive a multimodal regimen, including 6 cycles of R-CHOP, despite limited evidence. In low-risk diffuse large B-cell lymphoma, de-escalation to 4 R-CHOP cycles has proven non-inferior. It remains unclear whether similar de-escalation is feasible in PTL.
METHODS: Patients aged ≥ 18 years with Ann Arbor stage I-II PTL diagnosed between 2014 and 2021 were identified in the Netherlands Cancer Registry. Patients receiving ≥ 3 R-CHOP cycles were included. Outcomes were 5-year progression-free survival (PFS), overall survival (OS), and cumulative incidence function (CIF) of CNS-relapse, with follow-up through February 2024. For comparative analysis patients were limited to stage I disease and were categorized into 3 or ≥ 6 R-CHOP cycles.
RESULTS: A total of 144 patients were included (median age 71 years); CNS-relapse occurred in 12 of 17 relapsed patients; 83 % had stage I disease. A total of 87 stage I patients were included in the comparative analysis. Among these patients, 43 received 3 cycles and 44 received ≥ 6 cycles. Intrathecal methotrexate was administered in 94 %. No significant differences were observed in baseline characteristics or response rates. The 5-year PFS was 71 % versus 67 % (p = 0.82), OS 75 % versus 68 % (p = 0.97), and CNS-CIF 12 % versus 13 % (p = 0.46) for 3 versus ≥ 6 cycles, respectively.
CONCLUSION: In this nationwide cohort, nearly half of stage I PTL patients received 3 R-CHOP cycles without inferior outcomes. These real-world findings suggest de-escalation to 3 cycles may be a safe treatment approach in stage I patients and warrant prospective validation.
METHODS: Patients aged ≥ 18 years with Ann Arbor stage I-II PTL diagnosed between 2014 and 2021 were identified in the Netherlands Cancer Registry. Patients receiving ≥ 3 R-CHOP cycles were included. Outcomes were 5-year progression-free survival (PFS), overall survival (OS), and cumulative incidence function (CIF) of CNS-relapse, with follow-up through February 2024. For comparative analysis patients were limited to stage I disease and were categorized into 3 or ≥ 6 R-CHOP cycles.
RESULTS: A total of 144 patients were included (median age 71 years); CNS-relapse occurred in 12 of 17 relapsed patients; 83 % had stage I disease. A total of 87 stage I patients were included in the comparative analysis. Among these patients, 43 received 3 cycles and 44 received ≥ 6 cycles. Intrathecal methotrexate was administered in 94 %. No significant differences were observed in baseline characteristics or response rates. The 5-year PFS was 71 % versus 67 % (p = 0.82), OS 75 % versus 68 % (p = 0.97), and CNS-CIF 12 % versus 13 % (p = 0.46) for 3 versus ≥ 6 cycles, respectively.
CONCLUSION: In this nationwide cohort, nearly half of stage I PTL patients received 3 R-CHOP cycles without inferior outcomes. These real-world findings suggest de-escalation to 3 cycles may be a safe treatment approach in stage I patients and warrant prospective validation.