In Elderly Patients with Newly Diagnosed Aggressive B-Cell Lymphoma, the Rate of Change in Body Weight after the First Course R-CHOP (-like) Chemo Therapy Has Effect on Their Survival

Abstract

Background The incidence of B-cell lymphoma increases with age, and over 40% occurs in patients at age of 70 years old or more. Aggressive B-cell lymphoma was often treated with R-CHOP (-like) regimen. However, in elderly B-cell lymphoma patients, treatment intensification often must be lowered due to the risks of comorbidities and organ function deterioration, and treatment outcomes are worse compared to younger patients. The optimal dose of R-CHOP (-like) therapy is necessary to improve the outcome of the elderly patients with B-cell lymphoma. We conducted a retrospective cohort study examining the influence of the rate of change in body weight after the first chemo therapy on their outcomes and survival. Methods Clinical records of 111 patients who had received R-CHOP (-like) regimen were retrospectively analyzed. They were all over 73 years old, and newly diagnosed with aggressive B-cell lymphoma by WHO 2008 criteria. They were treated at Japanese Red Cross Kyoto Daiichi Hospital between January 1st 2008 and December 31st 2017. Data on clinical characteristics and treatment modalities were obtained through the review of medical charts. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The impact of variables on PFS and OS was evaluated by univariate log-rank tests and by multivariate analysis using the Cox proportional hazards model. Results Median age at diagnosis was 78 years old (73-94). The 2-year OS rate was 77.5% (95%Cl: 68.3-84.3%), PFS rate was 77.4% (95%Cl: 68.2-84.3%) in all patients. The 5-year OS rate was 62.3% (95%Cl: 50.2-72.2%), PFS rate was 55.5% (95%Cl: 43.4-66%) in all patients. The average rate of change in body weight after the first therapy was 4.59%. Large changes in body weight ( >9.3%) after the first therapy had worse clinical outcomes with shorter median OS (1.43 years vs. NA, P <0.001 HR 4.39, 95% CI 2.14 to 8.99, see figure 1) and median PFS (1.43 years vs. 6.9 years, P<0.001, HR 3.65, 95%CI 1.82to 7.29, see figure 2). Conclusion Large changes in body weight ( >9.3%) after the first therapy were associated with poor outcomes in elderly people with newly diagnosed aggressive B-cell lymphoma. This suggests that adjusting drug dosage on and after the second therapy in those patients has possible to be improve their survival. Disclosures No relevant conflicts of interest to declare.

Outcomes of diffuse large B-cell lymphoma in elderly patients – real-world experience from a middle-income country setting

“…The average life-expectancy in India is 66.6 years for men and 69.4 years for women [7]. Management of these patients remains a challenge due to the following reasons: presence of significant co-morbidities and frailty, delayed access to care, significant socioeconomic dependence, under-representation in prospective clinical trials, scanty literature and lack of an evidence-based approach, aggressive disease biology, higher toxicity, compromised dosing and early curtailment of treatment [5,[8][9][10].…”

“…Elderly patients are at an increased risk of toxicity of chemotherapy. Very significant changes in weight, nutritional status and easy fatigability, accompanied by poorly controlled comorbidities have been observed [5,9]. The shorter survival could also relate to a trend in the prescription of weaker treatments assumed to be better tolerated [2].…”