Background: Lymphoproliferative disorders have increased in last decades. The value of the cyclophosphamide, adriamycin, vincristine and prednisone (CHOP) plus rituximab (R-CHOP) combination therapy in both aggressive and indolent B-cell lymphoma has been demonstrated in several clinical trials. Treatment of patients > 65 years remains controversial and chemotherapy dose has been decreased due to comorbities, particularly cardiac insuficiency

Methods: Retrospective, comparative, non randomized study. Inclussion criteria: > 65 years patients with hystologically diagnosis of DLBCL, treated in a single national reference, from January 2011 until January 2015. Demographic characteristics, comorbidities were analyzed. Three regimens of treatment (RCHOP , RChOP & RCOP, see doses in table) were compared in terms of response, efficacy and survival. Descriptive analysis was done fore demographic & clinical characteristics. Suvival was calculated with Kaplan-Meier method Log rank test analysis was done to compare DFS & OS, stratifed by treatment regimen.

Results:

141 cases, with a median age of 74.15 y (range 65- 96 y), None difference was found among the 3 treatment regimens for the following variables: Comorbities are detailed by treatment group in the following table. (25 % Diabetes mellitus, 29 % blood hypertension), B symptoms (70 %), clinical stage III- IV ( 68 %), most had an adequate ECOG (1-2: 90 %), and most were considere as high-intermediate or high risk (68 %) according with R-IPI scale. However, only a higher proportion of patients with GC subtype was documented in RCHOP patients (54.7 % vs 35 % and 27.1% in RChOP & RCOP groups, respectively.

Global response (CR + PR) was achieved in 77.3 %, 60 % & 68.8 % in patients treated with RCHOP, RChop & RCOP, respectively. The following table describes toxicities by treatment regimen. DFS (but not OS) and OS was better in patients with RCHOP.

Table.
RCHOPRChoPRCOPP
Doses 375 mg/m² RTX, 750 mg/m² CFM, 50 mg/m² DOXO, 1.4 mg VCR ,100 mg daily x 5 PDN 375 mg/m² RTX, 750 mg/m² CFM, 25 mg/m² DOXO, 1.4 mg VCR ,100 mg daily x 5 PDN 375 mg/m² RTX, 750 mg/m² CFM, 1.4 mg VCR ,100 mg daily x 5 PDN -- 
N (%) 53 (100) 48 (100) 40 (100) -- 
Blood arterial hypertention 26.4 % 27.1 % 35 % 0.62 
Diabetes mellitus 11.3 % 25 % 32.5 % 0.042 
DiabeteR-IPI (3-4) 58.5 % 60.4 % 65 % 0.85 
Complications of treatment:  
Infections
None/ambulatory/hospitalization 		18/15/8 14/12/1112 23/10/43 0.090 
Myelosupression
None/none without transfusion required/ required transfusion 
36/6/11 		30/8/10 26/5/9 0.948 
Other complication (G III-IV):
None
Cardiovascular
Renal
Gastrointestinal
Neuropathy
Thrombosis 		-
28
8
4
8
1
1 		-
17
5
7
5
5
3 		-
24
4
2
6
2
0 		0.359 
Disease free survival
Median (P25-P75) 		-
33.26 (25.43-39.10) 		26.13(19.85-30.33) 36.16 (26.76-37.83) 0.011 
Overall survival
Media (95 % Confidence interval) 		37.7 (32.7-42.7)) 29.44 (23.60-35.28) 27.09 (20.81-33.37) 0.135 
RCHOPRChoPRCOPP
Doses 375 mg/m² RTX, 750 mg/m² CFM, 50 mg/m² DOXO, 1.4 mg VCR ,100 mg daily x 5 PDN 375 mg/m² RTX, 750 mg/m² CFM, 25 mg/m² DOXO, 1.4 mg VCR ,100 mg daily x 5 PDN 375 mg/m² RTX, 750 mg/m² CFM, 1.4 mg VCR ,100 mg daily x 5 PDN -- 
N (%) 53 (100) 48 (100) 40 (100) -- 
Blood arterial hypertention 26.4 % 27.1 % 35 % 0.62 
Diabetes mellitus 11.3 % 25 % 32.5 % 0.042 
DiabeteR-IPI (3-4) 58.5 % 60.4 % 65 % 0.85 
Complications of treatment:  
Infections
None/ambulatory/hospitalization 		18/15/8 14/12/1112 23/10/43 0.090 
Myelosupression
None/none without transfusion required/ required transfusion 
36/6/11 		30/8/10 26/5/9 0.948 
Other complication (G III-IV):
None
Cardiovascular
Renal
Gastrointestinal
Neuropathy
Thrombosis 		-
28
8
4
8
1
1 		-
17
5
7
5
5
3 		-
24
4
2
6
2
0 		0.359 
Disease free survival
Median (P25-P75) 		-
33.26 (25.43-39.10) 		26.13(19.85-30.33) 36.16 (26.76-37.83) 0.011 
Overall survival
Media (95 % Confidence interval) 		37.7 (32.7-42.7)) 29.44 (23.60-35.28) 27.09 (20.81-33.37) 0.135 
View Large

Conclussion: The group of patients treated with RChOP & RCOP had a worse DFS and but not OS, which may be influenced by a either higher proportion of patients with non-GC subtype, or reduction of anthracycline dose. Although regimens with chemotherapy dose reductions (mini-RCHOP) have been accepted for these patients, an individual evaluation is recommended in this population.

Disclosures

No relevant conflicts of interest to declare.

Topics:
anthracycline antibiotics, b-cell lymphomas, diffuse large b-cell lymphoma, mexico, older adult, chemotherapy regimen, diabetes mellitus, transfusion, combined modality therapy, cyclophosphamide

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2015 by The American Society of Hematology
2015
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