FLY high.

The standard approaches for treating favorable, early-stage diffuse large B-cell lymphoma (DLBCL) are 3 cycles of R-CHOP followed by involved site radiation or 6 cycles of R-CHOP alone. Patients in the latter category may be spared toxicity by doing 6 cycles of the rituximab but only 4 cycles of the CHOP. In the FLYER trial, patients 60 years or younger with stage I-II DLBCL and no other risk factors (e.g., elevated LDH, low performance status, bulky disease) were randomized to receive either 6 cycles of R-CHOP or 6 cycles of R and 4 cycles of CHOP. Neither arm received radiation. The trial tested whether the experimental arm had a non-inferior (within 5.5%) 3 year progression-free survival rate. That difference was only 3% at 3 years—favoring the fewer cycles of CHOP. As expected, there was less toxicity with fewer chemo cycles. TBL: In patients with favorable stage I-II DLBCL, only 4 cycles of R-CHOP with 2 additional cycles of the R results in non-inferior disease outcomes compared to the standard R-CHOP x 6. | Poeschel, Lancet 2019