According to results of a retrospective cohort study of patients with diffuse large B-cell lymphoma (DLBCL), the average relative dose intensity (ARDI) of first-line rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisone (R-CHOP) immunochemotherapy is a predictor of clinical outcomes — independent of the international prognostic index (IPI) — for this patient population. This study was published online in Cancer Medicine

The IPI, an assessment of specific patient- and disease-related risk factors, has previously been demonstrated to predict progression-free (PFS) and overall survival (OS) in patients with DLBCL. The aim of this study was to evaluate the ARDI of R-CHOP — an assessment of the mean value of the relative-dose intensity of the entire immunochemotherapy regimen — as an independent predictor of clinical outcomes in a cohort of patients with DLBCL.

This study included 223 patients with DLBCL who received at least 4 cycles of first-line treatment with R-CHOP between 2005 and 2013. The ARDI of R-CHOP was determined for all cycles for each patient using a specially developed computer program. Factors taken into account included patient body surface area, and the planned and actual doses of drugs administered, as well as the dates of drug administration. The IPI was calculated for all patients at diagnosis.  

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Multivariate analyses showed an R-CHOP ARDI of more than 90% to be associated with prolonged PFS (hazard ratio [HR]=0.31; 95% confidence interval [CI], 0.20-0.47) and overall survival (HR=0.32; 95% CI, 0.21-0.48) (P <.00001), regardless of the IPI. The most common reason for lower ARDI was neutropenia, which occurred in nearly half of the patients, with cardiotoxicity resulting in dose reductions of some of the cytotoxic agents in approximately 20% of the patients enrolled in the study.  

In conclusion, the authors wrote that supportive measures, such as “the early introduction of primary neutropenia prophylaxis” and “primary cardioprotection methods” are particularly important to maintain the ARDI of R-CHOP at levels more than 90% in patients with DLBCL.


  1. Długosz-Danecka M, Szmit S, Ogórka T, Skotnicki AB, Jurczak W. The average relative dose intensity of R-CHOP is an independent factor determining favorable overall survival in diffuse large B-cell lymphoma patients [published online February 10, 2019]. Cancer Med. doi: 10.1002/cam4.2008