{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:06:31Z","timestamp":1789016791781,"version":"build-2803163510"},"reference-count":27,"publisher":"American Society of Hematology","issue":"18","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Diffuse large B-cell lymphoma (DLBCL) and osteoporotic fracture are both more common in older patients. Exposure to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) is likely to increase the risk of fracture, but evidence is lacking to define fracture incidence in this group. Data on consecutive patients with DLBCL aged \u226570 years treated with 1 to 8 cycles of full or attenuated R-CHOP were retrospectively collected across 10 UK centers (2009-2019). Patients were followed up from starting R-CHOP for a minimum of 6 months and censored at 18 months; at last follow-up if &amp;lt;18 months; or at progression or death. Of 877 patients identified, 148 were excluded: 121 had progression or died before 6 months; 23 had follow-up &amp;lt;6 months. Across 729 remaining patients, the median age was 77 years, and 68% had an Eastern Cooperative Oncology Group performance status of 0 to 1. Eighty-one fractures occurred within 18 months of follow-up; 42 were symptomatic, including 30 requiring hospital attendance or admission. The cumulative fracture incidence was 6.2% (95% confidence interval [CI], 4.7-8.2) at 6 months; 9.7% (95% CI, 7.8-12.1) at 12 months; and 11.4% (95% CI, 9.3-14.0) at 18 months. Multivariate analysis identified a predisposing history (osteoporosis, osteopenia, prior fracture, and rheumatoid arthritis [RhA]), DLBCL bone involvement at baseline, and receipt of prephase steroids as independent risk factors for fracture. There is a clinically relevant fracture risk and significant associated morbidity in older patients receiving R-CHOP. Careful attention to bone health is warranted in older patients receiving R-CHOP. Randomized studies are required to better define the most effective strategies to reduce fracture risk.<\/jats:p>","DOI":"10.1182\/bloodadvances.2020002553","type":"journal-article","created":{"date-parts":[[2020,9,10]],"date-time":"2020-09-10T14:58:20Z","timestamp":1599749900000},"page":"4337-4346","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":15,"title":["Fractures are common within 18 months following first-line R-CHOP in older patients with diffuse large B-cell lymphoma"],"prefix":"10.1182","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-0234","authenticated-orcid":false,"given":"Stephen","family":"Booth","sequence":"first","affiliation":[{"name":"Department of Haematology, Oxford University Hospitals, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Plaschkes","sequence":"additional","affiliation":[{"name":"University of Oxford Medical 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Milton Keynes Hospital, Milton Keynes, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Willan","sequence":"additional","affiliation":[{"name":"Department of Haematology, Oxford University Hospitals, Oxford, United Kingdom;"},{"name":"Wexham Park Hospital, Frimley Heath NHS Foundation Trust, Slough, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Haematology, Great Western Hospital NHS Foundation Trust, Wiltshire, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arief","family":"Gunawan","sequence":"additional","affiliation":[{"name":"Department of Haematology, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Fields","sequence":"additional","affiliation":[{"name":"Department of Haematology, Guy\u2019s and St. Thomas\u2019 NHS Foundation Trust, London, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Ebsworth","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Southampton, Southampton, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Lown","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Southampton, Southampton, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Gordon-Walker","sequence":"additional","affiliation":[{"name":"Department of Haematology, Norfolk and Norwich University Hospitals, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimish","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Haematology, Norfolk and Norwich University Hospitals, United 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