Impact of Anthracycline Dose in Elderly Patients with Difusse Large B Cell Lymphoma (DLBCL) at the Instituto Nacional De Cancerologia Mexico

• Published in: Blood 2015-12, Vol.126 (23), p.5066-5066
• Main Authors: Nolasco -Medina, Diana, Alejandro, Mohar, Reynoso-Noveron, Nancy, Aviles-Salas, Alejandro, Garcia, Osvaldo, Candelaria, Myrna
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V126.23.5066.5066

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. TableRCHOPRChoPRCOPPDoses375 mg/m² RTX, 750 mg/m² CFM, 50 mg/m² DOXO, 1.4 mg VCR ,100 mg daily x 5 PDN375 mg/m² RTX, 750 mg/m² CFM, 25 mg/m² DOXO, 1.4 mg VCR ,100 mg daily x 5 PDN375 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 hypertention26.4 %27.1 %35 %0.62Diabetes mellitus11.3 %25 %32.5 %0.042DiabeteR-IPI (3-4)58.5 %60.4 %65 %0.85Complications of treatment:Infections None/ambulatory/hospitalization18/15/814/12/111223/10/430.090MyelosupressionNone/none without transfusion required/ required transfusion36/6/113