Vinorelbine as substitute for vincristine in patients with diffuse large B cell lymphoma and vincristine-induced neuropathy

Support Care Cancer. 2021 Sep;29(9):5197-5207. doi: 10.1007/s00520-021-06059-2. Epub 2021 Feb 24.


Background: A combination of rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard first-line therapy for diffuse large B cell lymphoma (DLBCL), the most common aggressive lymphoma in adults. One of the major adverse effects of this regimen is vincristine-induced polyneuropathy which leads to discontinuation of vincristine in up to 30% of DLBCL-patients. Dose reduction of vincristine might worsen treatment outcomes of DLBCL but identification of treatment alternatives for patients exhibiting peripheral neuropathy during R-CHOP is an unmet need in hematology.

Methods: In this retrospective cohort study, comprising 987 patients with de novo DLBCL, we delineated the role of vinorelbine as a substitute for vincristine in R-CHOP by measuring improvements in neuropathy and outcome variables.

Results: Five-year overall survival (OS) and progression-free survival (PFS) were 72.6% and 63.1% in patients who received regular doses of vincristine, as compared to 60.6% and 51.7% in patients who received reduced doses of vincristine (p = 0.022 and p = 0.003, respectively). Of 199 patients who switched to vinorelbine, the majority experienced an improvement of neuropathy Furthermore, vinorelbine-switched patients showed favorable oncologic outcomes.

Conclusion: Replacement of vincristine by vinorelbine due to neuropathy is effective and safe, and results in a significant improvement in neuropathy as compared to treatment with R-CHOP.

Keywords: DLBCL; Peripheral neuropathy; R-CHOP; Vino-R-CAP; Vinorelbine.

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Cyclophosphamide / adverse effects
  • Doxorubicin / adverse effects
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Lymphoma, Large B-Cell, Diffuse* / drug therapy
  • Male
  • Middle Aged
  • Peripheral Nervous System Diseases* / chemically induced
  • Peripheral Nervous System Diseases* / epidemiology
  • Prednisone / adverse effects
  • Retrospective Studies
  • Rituximab / adverse effects
  • Transplantation, Autologous
  • Vincristine / adverse effects
  • Vinorelbine


  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Vinorelbine
  • Prednisone