Management strategies and outcomes for very elderly patients with diffuse large B‐cell lymphoma

• DOI: 10.1002/cncr.30173
• Publication Date: 2016-06-29T10:17:19Z
• Authors: Dai Chihara; Jason R. Westin; Yasuhiro Oki; Mohamed A. Ahmed; Bryan Do; Luis E. Fayad; Fredrick B. Hagem...; Jorge E. Romaguera; Michelle A. Fanale; Hun J. Lee; Francesco Turturro; Felipe Samaniego; Sattva S. Neelapu; M. Alma Rodriguez; Nathan H. Fowler; Michael Wang; Richard E. Davis; Loretta J. Nastoupil
• Keywords: International Prognostic Index; Epoch (astronomy); Regimen; Tolerability

BACKGROUND The number of elderly patients with diffuse large B‐cell lymphoma (DLBCL) in our aging society continues to rise, although the optimal management very DLBCL is unknown. METHODS This study evaluated 207 who were 80 years old or older at diagnosis from 2002 2014 University Texas MD Anderson Cancer Center. Analyzed features included clinical characteristics, treatment outcomes, and tolerability therapy. Cox proportional hazards models examined relations between regimen survival. RESULTS median age was 83 (range, 80‐96 years). Fifty‐four percent had intermediate‐ high‐risk International Prognostic Index scores. Fifteen scores 4 higher on Charlson Comorbidity (CCI). initial therapies rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R‐CHOP; 70%); etoposide, prednisone, doxorubicin (R‐EPOCH; 6%); non–anthracycline‐based therapies, including (R‐CEOP) (R‐CVP; 10%). With a follow‐up 38.1 months, 3‐year failure‐free survival (FFS) overall (OS) rates 55% 54%, respectively. Eighty‐eight experienced relapse during follow‐up, but only 3 (3.4%) beyond years. Patients received R‐CHOP R‐EPOCH significantly longer FFS than those R‐CEOP R‐CVP, 63% for R‐CHOP, 74% R‐EPOCH, 23% R‐CVP. Male sex, monocyte count ≥ 500 × 10 7 /L, CCI score associated inferior OS. Extranodal disease (≥2) high risk treatment‐related mortality. CONCLUSIONS anthracycline‐based regimens such as superior outcomes similar achieved younger DLBCL. 2016;122:3145–51 . © 2016 American Society