Outcomes for R-CHOP Worse in Morning for Female Patients With Lymphoma

MONDAY, Feb. 6, 2023 (HealthDay News) — Female patients with diffuse large B-cell lymphoma (DLBCL) have worse outcomes when receiving rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in the morning, according to a study published online Dec. 13 in JCI Insight.

Dae Wook Kim, from KAIST in Daejeon, South Korea, and colleagues performed a chemotherapeutic analysis using two cohorts of patients with DLBCL undergoing chemotherapy. The effect of R-CHOP treatment in a morning versus afternoon schedule was examined in a survival cohort of 210 patients and an adverse event cohort of 129 patients. Circadian variation in hematologic parameters was examined in about 14,000 healthy individuals.

The researchers found that for female but not male patients, progression-free and overall survival were significantly shorter when patients received chemotherapy mostly in the morning (hazard ratios, 0.357 and 0.141, respectively). Female patients treated in the morning had reduced dose intensity (cyclophosphamide, 10 percent; doxorubicin, 8 percent; and rituximab, 7 percent). This finding was mainly due to infection and neutropenic fever, with a higher incidence of infections (16.7 versus 2.4 percent) and febrile neutropenia (20.8 versus 9.8 percent) for female patients treated in the morning versus the afternoon. Larger daily fluctuation of circulating leukocytes and neutrophils was seen in female versus male patients, which can explain the sex-specific chemotherapeutic effect.

“We conclude that female patients should, if possible, avoid receiving R-CHOP in the morning for optimal chemotherapy delivery with maximum response,” the authors write.

Abstract/Full Text