Outcome of Elderly Patients with Aggressive Non-Hodgkin's Lymphoma Refractory to or Relapsing after First-line CHOP or CHOP-like Chemotherapy: A Low Probability of Cure

Jabbour, Elias; Chalhoub, B.; Suzan, Florence; Aloulou, Samir; Căinap, Călin; Toumi, Nabil; Fermé, Christophe; Carde, Patrice; Ribrag, Vincent

doi:10.1080/10428190310001653736

Cited by 17 publications

(7 citation statements)

References 8 publications

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“…Except perhaps for patients with acute leukaemia (Jabbour et al . ) and Hodgkin's lymphoma (Evens & Hong ), however, there is generally a paucity of evidence to suggest that elderly patients receiving chemotherapy actually have a poorer outcome than younger patients. Furthermore, recent studies in small cell lung cancer and metastatic colorectal cancer have in fact indicated overall response rates and survival outcomes with chemotherapy being similar in younger and older patients (Fisher et al .…”

Section: Discussionmentioning

confidence: 99%

“…On the one hand, some studies have suggested that older patients may receive less intense, and therefore potentially inferior, therapy perhaps with the assumption that they are more likely to develop treatment-related toxicities and are less likely to respond (Chen et al 2003;Lichtman et al 2003;Yee et al 2003). Except perhaps for patients with acute leukaemia (Jabbour et al 2004) and Hodgkin's lymphoma (Evens & Hong 2013), however, there is generally a paucity of evidence to suggest that elderly patients receiving chemotherapy actually have a poorer outcome than younger patients. Furthermore, recent studies in small cell lung cancer and metastatic colorectal cancer have in fact indicated overall response rates and survival outcomes with chemotherapy being similar in younger and older patients ) (Cunningham et al 2013) .…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes following neoadjuvant cisplatin-based chemotherapy for bladder cancer in elderly compared with younger patients

Chau

Wheater

Geldart

et al. 2015

Eur J Cancer Care (Engl)

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Bladder cancer is a disease of the elderly. Older patients might potentially be undertreated due to assumptions about benefit versus risk. Our objective was to determine outcomes in older patients receiving neoadjuvant chemotherapy for muscle-invasive bladder cancer (MIBC). We hypothesised that appropriately selected elderly patients (≥70 years) with MIBC could have similar clinical outcomes, and be safely treated, with standard neoadjuvant chemotherapy prior to definitive cystectomy or radiotherapy. We utilised a single institution case series analysis of patients with T2-4a N0 M0 transitional cell carcinoma of the bladder treated with cisplatin-based neoadjuvant chemotherapy between 2005 and 2011. Eighty-three patients were eligible. Median age was 68 (range 48-80), 33 patients (40%) were ≥70 years. Overall survival at 3 years was 65.8% (≥70) and 63.2% (<70) (P = 0.653), relapse-free survival at 3 years was 61.6% and 54.8% respectively (P = 0.471). The rates going forward to definitive local therapy (87.9% ≥ 70 and 84.0% < 70) and the pathological complete response rate (31.3% ≥ 70 and 40% < 70) were similar. Disease relapse rate was also similar (63.6% ≥ 70 vs. 60% < 70, P = 0.906). Elderly patients with good functional status and limited comorbidities diagnosed with MIBC receiving standard neoadjuvant chemotherapy followed by cystectomy or radiotherapy can have similar clinical outcomes as their younger counterparts. Prospective studies evaluating the optimum curative management in this elderly population are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical outcomes following neoadjuvant cisplatin-based chemotherapy for bladder cancer in elderly compared with younger patients

Chau

Wheater

Geldart

et al. 2015

Eur J Cancer Care (Engl)

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“…Patients who are ineligible for HDT followed by ASCT, as described in the bone marrow transplant guidelines, have distinctly lower survival rates (Feugier et al , ; Thieblemont & Coiffier, ). Treatment options comprise conventional chemotherapy, enrolment in phase I or II clinical trials, radiotherapy in localized lesions, rituximab therapy and optimal supportive care (Jabbour et al , ; Murthy et al , ).…”

Section: How To Manage Dlbcl Patients Who Are Not Eligible For High‐dmentioning

confidence: 99%

How I manage patients with relapsed/refractory diffuse large B cell lymphoma

2018

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SummaryDespite progress in the upfront treatment of diffuse large B cell lymphoma (DLBCL), patients still experience relapses. Salvage chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard second‐line treatment for relapsed and refractory (R/R) DLBCL. However, half of the patients will not be eligible for transplantation due to ineffective salvage treatment, and the other half will relapse after ASCT. In randomized studies, no salvage chemotherapy regimen is superior to another. The outcomes are affected by the secondary International Prognostic Index at relapse and various biological factors. The strategy is less clear in patients who require third‐line treatment. A multicohort retrospective non‐Hodgkin lymphoma research (SCHOLAR‐1) study conducted in 636 patients with refractory DLBCL showed an objective response rate of 26% (complete response 7%) to the next line of therapy with a median overall survival of 6·3 months. In the case of a response followed by transplantation, long‐term survival can be achieved in DLBCL patients. There is clearly a need for new drugs that improve salvage efficacy. Encouraging results have been reported with chimeric antigen receptor ‐T cell engineering, warranting further studies in a well‐defined control group of refractory patients. The Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) was used as a handy framework to build the discussion.

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“…Patients who are ineligible for high-dose chemotherapy followed by autologous SCT as described in the bone marrow transplant guidelines have distinctly lower survival rates. 10,32,33 Treatment options comprise enrolment in Phase I or II clinical trials, palliative care with radiotherapy, rituximab therapy, and optimal supportive care. 34…”

Section: Management Of Refractory Diffuse Large B Cell Lymphoma In Pa...mentioning

confidence: 99%

Bridging to Transplant in Diffuse Large B Cell Lymphoma

Gisselbrecht

Neste

2016

EMJ Hematol

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Non-Hodgkin lymphoma (NHL) is the eighth most common malignancy worldwide. Diffuse large B cell lymphoma (DLBCL) is the most frequent subtype, accounting for >30% of NHL cases. Advances in novel approaches in the last two decades, such as immunotherapy with rituximab, have achieved improvements in terms of overall and long-term survival rates. The current standard of care for the first-line treatment of DLBCL is chemotherapy with rituximab plus cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone; this regimen achieves complete and sustained remission in approximately 60% of patients. Nevertheless, DLBCL relapses in 30–40% of patients, of which 10% develop refractory disease. Recent findings have demonstrated that substantial responses could be achieved after second or third-line treatments with combined chemotherapy. Since 2012, the aza-anthracenedione, pixantrone, has been approved as a single agent for relapsed or refractory DLBCL. The drug could be a new option as a bridging therapy to consolidate autologous or allogeneic stem cell transplantation, which in turn, can deliver prolonged durations of remission. Numerous clinical studies are ongoing that aim to improve salvage rates, outcomes, and access to stem cell transplantations for relapsed or refractory DLBCL. The development of novel targeted therapies or chemotherapeutics, such as pixantrone, will help to salvage more patients and achieve further sustained and complete responses without compromising their quality of life.

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Outcome of Elderly Patients with Aggressive Non-Hodgkin's Lymphoma Refractory to or Relapsing after First-line CHOP or CHOP-like Chemotherapy: A Low Probability of Cure

Cited by 17 publications

References 8 publications

Clinical outcomes following neoadjuvant cisplatin-based chemotherapy for bladder cancer in elderly compared with younger patients

Clinical outcomes following neoadjuvant cisplatin-based chemotherapy for bladder cancer in elderly compared with younger patients

How I manage patients with relapsed/refractory diffuse large B cell lymphoma

Bridging to Transplant in Diffuse Large B Cell Lymphoma

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