The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study

Mette Abildgaard Pedersen; Lars C Gormsen; Lasse H Jakobsen; Toby A Eyre; Marianne T Severinsen; Joachim Baech; Eldad J Dann; Andrea Knapp; Denis Sahin; Peter Vestergaard; Tarec C El-Galaly; Paw Jensen

doi:10.1111/bjh.19194

The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study

Mette Abildgaard Pedersen, Lars C Gormsen, Lasse H Jakobsen, Toby A Eyre, Marianne T Severinsen, Joachim Baech, Eldad J Dann, Andrea Knapp, Denis Sahin, Peter Vestergaard, Tarec C El-Galaly, Paw Jensen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Standard CHOP treatment includes a high cumulative dose of prednisone, and studies have shown increased fracture risk following CHOP. It is unclear whether reductions in bone mineral density (BMD) are caused by glucocorticoids or by the combination with chemotherapy. Our objective was to determine the effect of obinutuzumab (G)/rituximab (R)-bendamustine versus G/R-CHOP on BMD in follicular lymphoma patients. Patients in this GALLIUM post hoc study were ≥60 years old and in complete remission at induction treatment completion (ITC), following treatment with G or R in combination with bendamustine or CHOP. To assess BMD, Hounsfield units (HU) were measured in lumbar vertebra L1 on annual computed tomography. Furthermore, vertebral compression fractures were recorded. Of 173 patients included, 59 (34%) received CHOP and 114 (66%) received bendamustine. At baseline, there was no difference in HU between groups. The mean HU decrease from baseline to ITC was 27.8 after CHOP and 17.3 after bendamustine, corresponding to a difference of 10.4 (95% CI: 3.2-17.6). Vertebral fractures were recorded in 5/59 patients receiving CHOP and in 2/114 receiving bendamustine. CHOP was associated with a significant greater decrease in BMD and more frequent fractures. These results suggest that prophylaxis against BMD loss should be considered.

Original language	English
Journal	British Journal of Haematology
Volume	204
Issue	4
Pages (from-to)	1271-1278
Number of pages	8
ISSN	0007-1048
DOIs	https://doi.org/10.1111/bjh.19194
Publication status	Published - Apr 2024

Keywords

CHOP
chemotherapy
clinical studies
late effects of therapy
non-Hodgkin lymphoma
Bone Density
Fractures, Compression/drug therapy
Humans
Middle Aged
Bendamustine Hydrochloride/adverse effects
Lymphoma, Follicular/drug therapy
Antineoplastic Combined Chemotherapy Protocols/adverse effects
Prednisone/adverse effects
Vincristine/adverse effects
Rituximab/adverse effects
Spinal Fractures/drug therapy

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10.1111/bjh.19194Licence: CC BY-NC

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Pedersen, M. A., Gormsen, L. C., Jakobsen, L. H., Eyre, T. A., Severinsen, M. T., Baech, J., Dann, E. J., Knapp, A., Sahin, D., Vestergaard, P., El-Galaly, T. C., & Jensen, P. (2024). The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study. British Journal of Haematology, 204(4), 1271-1278. https://doi.org/10.1111/bjh.19194

@article{c35bd8213220460ca53c62ee77c32693,

title = "The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study",

abstract = "Standard CHOP treatment includes a high cumulative dose of prednisone, and studies have shown increased fracture risk following CHOP. It is unclear whether reductions in bone mineral density (BMD) are caused by glucocorticoids or by the combination with chemotherapy. Our objective was to determine the effect of obinutuzumab (G)/rituximab (R)-bendamustine versus G/R-CHOP on BMD in follicular lymphoma patients. Patients in this GALLIUM post hoc study were ≥60 years old and in complete remission at induction treatment completion (ITC), following treatment with G or R in combination with bendamustine or CHOP. To assess BMD, Hounsfield units (HU) were measured in lumbar vertebra L1 on annual computed tomography. Furthermore, vertebral compression fractures were recorded. Of 173 patients included, 59 (34%) received CHOP and 114 (66%) received bendamustine. At baseline, there was no difference in HU between groups. The mean HU decrease from baseline to ITC was 27.8 after CHOP and 17.3 after bendamustine, corresponding to a difference of 10.4 (95% CI: 3.2-17.6). Vertebral fractures were recorded in 5/59 patients receiving CHOP and in 2/114 receiving bendamustine. CHOP was associated with a significant greater decrease in BMD and more frequent fractures. These results suggest that prophylaxis against BMD loss should be considered.",

keywords = "CHOP, chemotherapy, clinical studies, late effects of therapy, non-Hodgkin lymphoma, Bone Density, Fractures, Compression/drug therapy, Humans, Middle Aged, Bendamustine Hydrochloride/adverse effects, Lymphoma, Follicular/drug therapy, Antineoplastic Combined Chemotherapy Protocols/adverse effects, Prednisone/adverse effects, Vincristine/adverse effects, Rituximab/adverse effects, Spinal Fractures/drug therapy",

author = "Pedersen, {Mette Abildgaard} and Gormsen, {Lars C} and Jakobsen, {Lasse H} and Eyre, {Toby A} and Severinsen, {Marianne T} and Joachim Baech and Dann, {Eldad J} and Andrea Knapp and Denis Sahin and Peter Vestergaard and El-Galaly, {Tarec C} and Paw Jensen",

note = "{\textcopyright} 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.",

year = "2024",

month = apr,

doi = "10.1111/bjh.19194",

language = "English",

volume = "204",

pages = "1271--1278",

journal = "British Journal of Haematology",

issn = "0007-1048",

publisher = "Wiley-Blackwell Publishing Ltd.",

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Pedersen, MA, Gormsen, LC, Jakobsen, LH, Eyre, TA, Severinsen, MT, Baech, J, Dann, EJ, Knapp, A, Sahin, D, Vestergaard, P, El-Galaly, TC & Jensen, P 2024, 'The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study', British Journal of Haematology, vol. 204, no. 4, pp. 1271-1278. https://doi.org/10.1111/bjh.19194

The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study. / Pedersen, Mette Abildgaard; Gormsen, Lars C; Jakobsen, Lasse H et al.
In: British Journal of Haematology, Vol. 204, No. 4, 04.2024, p. 1271-1278.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study

AU - Pedersen, Mette Abildgaard

AU - Gormsen, Lars C

AU - Jakobsen, Lasse H

AU - Eyre, Toby A

AU - Severinsen, Marianne T

AU - Baech, Joachim

AU - Dann, Eldad J

AU - Knapp, Andrea

AU - Sahin, Denis

AU - Vestergaard, Peter

AU - El-Galaly, Tarec C

AU - Jensen, Paw

PY - 2024/4

Y1 - 2024/4

N2 - Standard CHOP treatment includes a high cumulative dose of prednisone, and studies have shown increased fracture risk following CHOP. It is unclear whether reductions in bone mineral density (BMD) are caused by glucocorticoids or by the combination with chemotherapy. Our objective was to determine the effect of obinutuzumab (G)/rituximab (R)-bendamustine versus G/R-CHOP on BMD in follicular lymphoma patients. Patients in this GALLIUM post hoc study were ≥60 years old and in complete remission at induction treatment completion (ITC), following treatment with G or R in combination with bendamustine or CHOP. To assess BMD, Hounsfield units (HU) were measured in lumbar vertebra L1 on annual computed tomography. Furthermore, vertebral compression fractures were recorded. Of 173 patients included, 59 (34%) received CHOP and 114 (66%) received bendamustine. At baseline, there was no difference in HU between groups. The mean HU decrease from baseline to ITC was 27.8 after CHOP and 17.3 after bendamustine, corresponding to a difference of 10.4 (95% CI: 3.2-17.6). Vertebral fractures were recorded in 5/59 patients receiving CHOP and in 2/114 receiving bendamustine. CHOP was associated with a significant greater decrease in BMD and more frequent fractures. These results suggest that prophylaxis against BMD loss should be considered.

AB - Standard CHOP treatment includes a high cumulative dose of prednisone, and studies have shown increased fracture risk following CHOP. It is unclear whether reductions in bone mineral density (BMD) are caused by glucocorticoids or by the combination with chemotherapy. Our objective was to determine the effect of obinutuzumab (G)/rituximab (R)-bendamustine versus G/R-CHOP on BMD in follicular lymphoma patients. Patients in this GALLIUM post hoc study were ≥60 years old and in complete remission at induction treatment completion (ITC), following treatment with G or R in combination with bendamustine or CHOP. To assess BMD, Hounsfield units (HU) were measured in lumbar vertebra L1 on annual computed tomography. Furthermore, vertebral compression fractures were recorded. Of 173 patients included, 59 (34%) received CHOP and 114 (66%) received bendamustine. At baseline, there was no difference in HU between groups. The mean HU decrease from baseline to ITC was 27.8 after CHOP and 17.3 after bendamustine, corresponding to a difference of 10.4 (95% CI: 3.2-17.6). Vertebral fractures were recorded in 5/59 patients receiving CHOP and in 2/114 receiving bendamustine. CHOP was associated with a significant greater decrease in BMD and more frequent fractures. These results suggest that prophylaxis against BMD loss should be considered.

KW - CHOP

KW - chemotherapy

KW - clinical studies

KW - late effects of therapy

KW - non-Hodgkin lymphoma

KW - Bone Density

KW - Fractures, Compression/drug therapy

KW - Humans

KW - Middle Aged

KW - Bendamustine Hydrochloride/adverse effects

KW - Lymphoma, Follicular/drug therapy

KW - Antineoplastic Combined Chemotherapy Protocols/adverse effects

KW - Prednisone/adverse effects

KW - Vincristine/adverse effects

KW - Rituximab/adverse effects

KW - Spinal Fractures/drug therapy

U2 - 10.1111/bjh.19194

DO - 10.1111/bjh.19194

M3 - Journal article

C2 - 37957542

SN - 0007-1048

VL - 204

SP - 1271

EP - 1278

JO - British Journal of Haematology

JF - British Journal of Haematology

IS - 4

ER -

The impact of CHOP versus bendamustine on bone mineral density in patients with indolent lymphoma enrolled in the GALLIUM study

Abstract

Keywords

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