Diffuse large B-cell lymphoma in octogenarians aged 85 and older can benefit from treatment with curative intent: a report on 129 patients prospectively registered in the Elderly Project of the Fondazione Italiana Linfomi (FIL)

Abstract

Octogenarian patients with diffuse large B-cell lymphoma are managed mainly with palliation, but recent improvement in their overall condition makes potentially curative treatment a possibility. Studies have shown that half of selected octogenarians may be cured using reduced-dose anthracycline chemoimmunotherapy. However, patients aged >85 (late octogenarians–LO) were underrepresented, and selection criteria were poorly defined. We analyzed the clinical characteristics and outcomes of LO enrolled in the FIL Elderly Project (EP) in terms of the treatment received (palliative vs curative) and of their simplified geriatric assessment (sGA), then compared them with early octogenarians (EO) aged 80-84 and with those aged 65-79 classified as UNFIT or FRAIL according to sGA enrolled in the same study. Of the 1163 patients, 370 were >80 and 129 LO. Clinical characteristics were similar between LO and EO, but LO more frequently received palliation (50% vs 23%: P=0.001) and had worse 2-year overall survival (OS) (48% vs 63%: P=0.001) and 2-year progression-free survival (PFS) (43% vs 56%: P=0.01). Patients receiving anthracycline did better than patients receiving palliation (P

Cell cycle arrest: A breakthrough in the supportive care of older cancer patients

“…8 Frail individuals are at high risk for chemotherapy complications, whose incidence increases with the prevalence and severity of functional dependence, evaluated with a geriatric assessment. [9][10][11][12][13][14][15]32,33 With the current reactive approach to chemotherapy toxicity, frail patients may experience severe disabling complications and sometimes death, even when antidotes are utilized. Let us look at the example of neutropenia: if the concentration of myeloid precursors in the bone marrow is critically reduced the growth factor will not have the material necessary to build new neutrophils and protect from neutropenia.…”

“…Even in the presence of growth factors, the patient may die from a neutropenic infection. [9][10][11][12][13][14][15]34,35 In addition, chemotherapy itself may be a cause of frailty, as the functional reserve of multiple organ systems may become progressively depleted by each drug administration. Finally, the recovery from chemotherapy requires new proteins and more energy to rebuild the previously destroyed tissues.…”

“…Frailty is constructed as a critical reduction of functional reserve that may impair recovery from stress 8 . Frail individuals are at high risk for chemotherapy complications, whose incidence increases with the prevalence and severity of functional dependence, evaluated with a geriatric assessment 9–15,32,33 . With the current reactive approach to chemotherapy toxicity, frail patients may experience severe disabling complications and sometimes death, even when antidotes are utilized.…”

“…Let us look at the example of neutropenia: if the concentration of myeloid precursors in the bone marrow is critically reduced the growth factor will not have the material necessary to build new neutrophils and protect from neutropenia. Even in the presence of growth factors, the patient may die from a neutropenic infection 9–15,34,35 . In addition, chemotherapy itself may be a cause of frailty, as the functional reserve of multiple organ systems may become progressively depleted by each drug administration.…”

Long‐term efficacy in patients with relapsed/refractory diffuse large B‐cell lymphoma achieving a complete response with pixantrone

“…First-line therapy for patients with diffuse large B-cell lymphoma (DLBCL), including elderly patients, is an anthracycline-based regimen with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). [1][2][3] The 5-years progression-free survival (PFS) is about 50%; however, a significant proportion of cases experience refractory disease or relapse after an initial response. [2][3][4] Salvage therapy is represented by intensive regimens, followed by autologous stem-cell transplantation (ASCT) for eligible patients who achieve at least a partial response (PR); otherwise, chimeric antigen receptor (CAR) T-cells is the preferred treatment strategy.…”