A new prognostic model identifies patients aged 80 years and older with diffuse large B‐cell lymphoma who may benefit from curative treatment: A multicenter, retrospective analysis by the Spanish GELTAMO group

Abstract

The means of optimally managing very elderly patients with diffuse large B-cell lymphoma (DLBCL) has not been established. We retrospectively analyzed 252 patients aged 80-100 years, diagnosed with DLBCL or grade 3B follicular lymphoma, treated in 19 hospitals from the GELTAMO group. Primary objective was to analyze the influence of the type of treatment and comorbidity scales on progression-free survival (PFS) and overall survival (OS). One hundred sixty-three patients (63%) were treated with chemotherapy that included anthracyclines and/or rituximab, whereas 15% received no chemotherapeutic treatment. With a median follow-up of 44 months, median PFS and OS were 9.5 and 12.5 months, respectively. In an analysis restricted to the 205 patients treated with any kind of chemotherapy, comorbidity scales did not influence the choice of treatment type significantly. Independent factors associated with better PFS and OS were: age < 86 years, cumulative illness rating scale (CIRS) score < 6, intermediate risk (1-2) R-IPI, and treatment with R-CHOP at full or reduced doses. We developed a prognostic model based on the multivariate analysis of the 108 patients treated with R-CHOP-like: median OS was 45 vs. 12 months (P = .001), respectively, for patients with 0-1 vs. 2-3 risk factors (age > 85 years, R-IPI 3-5 or CIRS > 5). In conclusion, treatment with R-CHOP-like is associated with good survival in a significant proportion of patients. We have developed a simple prognostic model that may aid the selection patients who could benefit from a curative treatment, although it needs to be validated in larger series.

Type 2 diabetes mellitus compromises the survival of diffuse large B-cell lymphoma patients treated with (R)-CHOP – the PLRG report

“…www.nature.com/scientificreports www.nature.com/scientificreports/ from studies utilizing comorbidity indices, e.g. [18][19][20][21][22][23][24][25] , and covered mostly elderly patients, which could have allowed only for speculation on the impact of diabetes in all DLBCL patients (including younger patients). Therefore, we launched a retrospective study to determine the impact of DMT2 on the outcomes of DLBCL patients.…”

<p>Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models – A Systematic Review</p>

“…Fifteen of 46 studies reported 3-year OS for novel prognostic models, while OS was calculated from Kaplan-Meier curves for the rest 3,9,10,16,31,34,35,39,40,44,52,[56][57][58][59] (Tables 1-3). Only the minority of studies (six of 46) reported 3-year OS for compared indices.…”

Frontline treatments in extremely elderly patients with diffuse large B-cell lymphoma: a population-based study in Taiwan, 2010–2015

“…Similar limitation was found in one retrospective analysis from a multicenter study. Although this retrospective analysis showed that R-CHOP or R-CHOP like regimens improve the overall survival in patients aged 80 years and older with DLBCL or grade 3B follicular lymphoma, their reference group was palliative care, which failed to demonstrate the additional benefit of rituximab [6]. Because rituximab may increase the incidence of opportunistic infections, [7] the benefits associated with the addition of rituximab remain debatable in the treatment of DLBCL patients older than 80 years.…”

“…Therefore, the role of anthracycline remains debatable in DLBCL patients older than 80 years. Three retrospective studies showed that adding anthracycline did not influence overall survival in DLBCL patients older than 80 years [6,9,10].…”