Tailored Therapy in an Unselected Population of 91 Elderly Patients with DLBCL Prospectively Evaluated Using a Simplified CGA

Abstract

Learning Objectives: After completing this course, the reader will be able to: Demonstrate the proper use of a simplified comprehensive geriatric analysis, including activities of daily living (ADL), Mini‐Mental State Evaluation (MMSE), Cumulative Illness Rating Scale–Geriatrics (CIRS‐G), and geriatric syndromes (multidimensional geriatric assessment [MGA]). Maintaining a tailored anthracycline‐based therapy, describe alternative treatment in elderly diffuse large B‐cell lymphoma (DLBCL) patients unfit for the standard chemotherapy. This article is available for continuing medical education credit at http://CME.TheOncologist.com Background. Elderly patients with diffuse large B‐cell lymphoma (DLBCL) are a heterogeneous population; clinical trials have evaluated a minority of these patients. Patients and Methods. Ninety‐one elderly patients with DLBCL received tailored treatment based on a comprehensive geriatric assessment (CGA). Three groups were identified: I, fit patients; II, patients with comorbidities; III, frail patients. Group I received 21‐day cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP‐21), group II received R‐CHOP‐21 with liposomal doxorubicin, and group III received 21‐day cycles of reduced‐dose CHOP. Fifty‐four patients (59%) were allocated to group I, 22 (25%) were allocated to group II, and 15 (16%) were allocated to group III. Results. The complete response (CR) rates were 81.5% in group I, 64% in group II, and 60% in group III. With a median follow‐up of 57 months, 42 patients are alive, with 41 in continuous CR: 31 patients (57%) in group I, seven patients (32%) in group II, and four patients (20%) in group III. The 5‐year overall survival, event‐free survival, and disease‐free survival rates in all patients were 46%, 31%, and 41%, respectively. Multivariate analysis selected group I assignment as the main significant prognostic factor for outcome. Conclusions. This approach in an unselected population of elderly DLBCL patients shows that treatment tailored according to a CGA allows the evaluation of elderly patients who are currently excluded from clinical trials.

Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: a prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL)

“…The results of our study confirm that CGA is a strong independent predictor of overall survival [12,13] and can be usefully applied to the treatment decision in elderly patients with DLBCL. We adopted age 70 as the lower limit of clinical senescence since the prevalence of age-related changes is represented by an almost flat line up to this age and increases sharply with older age [3,14].…”

Role of anthracycline and comprehensive geriatric assessment for elderly patients with diffuse large B-cell lymphoma

“…Five prospective cohort studies, including 1 randomized controlled study, evaluated the use of CGA to guide treatment decision making in elderly patients with newly diagnosed DLBCL, are summarized in Table 2. [31][32][33][34][35] In total, 1732 patients were included in 9 retrospective studies. As shown in Table 1, most studies were small singleinstitution studies with missing data, especially data related to the comparison between anthracycline-containing or anthracycline-free regimens.…”

“…[31][32][33][34][35] In total, 452 patients were included in the 4 prospective observation studies. CGA categorized patients into fit and unfit/frail categories.…”

“…In the unfit subgroup of patients (n 5 28) from the study by Tucci et al, 34 curative-intent treatment with an anthracycline-containing regimen produced a 2-year OS of 75% vs 45% (P 5 .32) for palliative treatment with anthracycline-free regimens, anthracycline-based regimens with less than 70% relative dose intensity (RDI), radiation treatment, rituximab monotherapy, or supportive care alone. The unfit subgroup of patients (n 5 22) from the study by Olivieri et al 32 all received liposomal doxorubicin. Finally, in a retrospective analysis by Yoshida et al, 18 patients classified as unfit by CGA (n 5 53) who received curative-intent treatment with anthracycline-containing regimens had a significantly better 1-year OS when compared with those receiving palliative measures (66.1% vs 19.0%; P , .001).…”

Trends in incidence, treatment and survival of aggressive B-cell lymphoma in the Netherlands 1989-2010

“…Comprehensive geriatric assessment (CGA) could be used for additional information. 66,67 Since it is important to have more detailed information regarding exact treatments, dose adherence and comorbidities for a better understanding of the treatment and outcome of patients with hematologic malignancies, an extensive registry was initiated in the Netherlands, supplementary to the cancer registry. This PHAROS registry (Population-based Haematological Registry for Observational Studies) is expected to supply more detailed data in the near future.…”