Comparison of Three Chemotherapy Regimens in Elderly Patients with Diffuse Large B Cell Lymphoma: Experience at a Single National Reference Center in Mexico

• Published in: BioMed research international 2016-01, Vol.2016 (2016), p.1-10
• Main Authors: García-Perez, Osvaldo, Aviles-Salas, Alejandro, Mohar, Alejandro, Reynoso-Noveron, Nancy, Nolasco-Medina, Diana, Candelaria, Myrna
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged patients; Aged, 80 and over; Anthracyclines; Anthracyclines - administration & dosage; Anthracyclines - adverse effects; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antibodies, Monoclonal, Murine-Derived - adverse effects; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cancer; Chemotherapy; Clinical Study; Comorbidity; Comparative analysis; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Disease-Free Survival; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Drug therapy; Female; Frailty; Health aspects; Humans; Lymphoma; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - pathology; Male; Medical research; Medicine, Experimental; Mortality; Neutropenia; Non-Hodgkin's lymphomas; Prednisone - administration & dosage; Prednisone - adverse effects; Prognosis; Studies; Type 2 diabetes; Vincristine - administration & dosage; Vincristine - adverse effects
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2016/9817606

Background. Although chemotherapy added to rituximab is a standard of care for diffuse large B cell lymphoma (DLBCL), treatment of patients ≥65 years of age remains controversial due to comorbidities. Methods. This is a retrospective, comparative, nonrandomized study of patients ≥65 years of age, who were diagnosed with DLBCL but not previously treated. Demographic characteristics and comorbidities were analyzed. Three rituximab-containing treatment regimens (standard RCHOP, anthracycline dose-reduced RChOP, and RCOP) were compared. Descriptive analyses were conducted. Survival was calculated with the Kaplan-Meier method, and differences were compared with the log-rank test. Results. In total, 141 patients with a median age of 73.9 years were studied. The three treatment groups had comparable demographic characteristics. The overall response was 77%, 72.5%, and 59% in groups treated with RCHOP, RChOP, and RCOP, respectively. After multivariate analysis, the factors influencing the overall survival were the presence of B symptoms, poor performance status (ECOG ≥ 3), and febrile neutropenia. Factors influencing disease-free survival were febrile neutropenia, high-intermediate and high-risk IPI scores, and treatment without anthracycline. Conclusion. A higher ORR (overall response rate) was achieved with standard RCHOP, which influenced DFS and OS, although it was not statistically significant compared with the other groups. Interventional phase 3 trials testing new molecules in patients aged 70 to 80 years and older are required to improve the prognosis within this growing population.