What Determines Therapeutic Choices for Elderly Patients With DLBCL? Clinical Findings of a Multicenter Study in Portugal

Alvarez, Rute; Esteves, Susana; Chacim, Sérgio; Carda, José Pedro; Mota, Alexandra; Guerreiro, Manuel; Barbosa, Inês; Moita, Filipa; Teixeira, Adriana; Coutinho, Jorge; Príncipe, Fernando; Mariz, José; Silva, Maria Gomes

doi:10.1016/j.clml.2014.01.008

Cited by 8 publications

(13 citation statements)

References 33 publications

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“…Overall, our outcomes are comparable with those from Peyrade et al 12 . who found that the attenuated R‐mini‐CHOP regimen may enable remission, cure and/or good palliation without intolerable toxicity, and a few other reports 26,27 …”

Section: Discussionsupporting

confidence: 88%

Clinical characteristics and outcomes among 2347 patients aged ≥85 years with major lymphoma subtypes: a Nordic Lymphoma Group study

Wästerlid¹,

Gradel

Eloranta

et al. 2020

Br J Haematol

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Summary There is a lack of data regarding treatment and prognosis for the growing group of oldest old patients with lymphoma. Therefore, we studied 2347 patients aged ≥85 years from the Danish and Swedish lymphoma registers 2000–2016 (Denmark) and 2007–2013 (Sweden). Outcome was assessed using relative survival (RS). The 2‐year RS overall for patients with aggressive lymphomas was 38% [95% confidence interval (CI) 35–42%], of whom 845 (66%) patients received active treatment (chemotherapy, radiotherapy, immunotherapy, other). For aggressive lymphomas, not receiving active treatment was associated with an inferior 2‐year RS of 12% (95% CI 9–17%) compared to 49% (95% CI 45–53%) for patients who received active treatment (excess mortality rate ratio 2·84, 95% CI 2·3–3·5; P < 0·0001). For patients with indolent lymphoma, the 2‐year RS was 77% (95% CI 72–82%). Here, 383 (46%) patients received active treatment at diagnosis, but did not have better 2‐year RS (75%, 95% CI 67–81%) compared to those who did not receive active treatment (83%, 95% CI 74–89%). We conclude that outcomes for the oldest old patients with lymphoma are encouraging for several subtypes and that active treatment is associated with improved outcome amongst the oldest old patients with aggressive lymphomas, indicating that age itself should not be a contraindication to treatment.

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Section: Discussionsupporting

confidence: 88%

Clinical characteristics and outcomes among 2347 patients aged ≥85 years with major lymphoma subtypes: a Nordic Lymphoma Group study

Wästerlid¹,

Gradel

Eloranta

et al. 2020

Br J Haematol

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show abstract

“…Fifteen studies conducted between 2010 and 2016 fulfilled the inclusion criteria, including 9 retrospective cohort studies [20][21][22][23][24][25][26][27][28] and 2 administrative database-derived epidemiologic studies 29,30 comparing chemotherapy regimens with or without anthracyclines in elderly patients who had newly diagnosed DLBCL (Table 1). No randomized For personal use only.…”

Section: Impacts Of Anthracycline-containing Regimensmentioning

confidence: 99%

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

Lin

Behera

Diefenbach

et al. 2017

Blood

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Survival outcome for elderly patients with newly diagnosed diffuse large B-cell lymphoma remains suboptimal in the rituximab era. In this systematic review, we summarize available evidence relevant to the inclusion of anthracycline in upfront chemoimmunotherapy for these elderly patients and highlight the need of prospective clinical trials. With limited prospective data, we find that pretreatment comprehensive geriatric assessment accurately predicts survival and treatment-related toxicities, suggesting its potential role in guiding overall treatment decision-making.

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“…Similarly, in 690 consecutive British patients aged ≥70 treated with R‐CHOP, only 71% of patients completed at least six cycles of R‐CHOP 22 . In a Portuguese multicenter study including 378 patients aged 60 or above, 23% did not complete planned treatment 23 . Thus, the risk of non‐completion is a frequent clinical issue which has, as demonstrated in this study, a major impact on outcome.…”

Section: Discussionmentioning

confidence: 91%

Outcome and determinants of failure to complete primary R‐CHOP treatment for reasons other than non‐response among patients with diffuse large B‐cell lymphoma

et al. 2020

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Patients with diffuse large B‐cell lymphoma (DLBCL) who fail to complete planned treatment with R‐CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R‐CHOP for reasons unrelated to non‐response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R‐CHOP were identified through the Swedish lymphoma register 2007‐2014. Of these, 147 (5%) stopped prematurely after 1‐3 cycles of R‐CHOP for reasons unrelated to non‐response, 168 (5%) after 4‐5 cycles and 2639 patients (84%) completed planned treatment. Additionally, 195 (6%) patients did not complete treatment due to non‐response or death before treatment end. In a multivariable logistic regression model, age > 75 years, poor performance status, extranodal disease and Charlson Comorbidity Index ≥1 were significantly associated with failure to complete planned R‐CHOP treatment for other reasons than non‐response. Non‐completion of treatment strongly correlated with survival. Five‐year overall survival for patients who received 1‐3 cycles was 26% (95% CI: 19%‐33%), 49% (95% CI: 41%‐57%) for 4‐5 cycles and 76% (74%‐77%) for patients who completed treatment. Failure to complete planned R‐CHOP treatment is an important clinical issue associated with inferior survival. Old age and poor performance status most strongly predict such failure. These results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.

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What Determines Therapeutic Choices for Elderly Patients With DLBCL? Clinical Findings of a Multicenter Study in Portugal

Cited by 8 publications

References 33 publications

Clinical characteristics and outcomes among 2347 patients aged ≥85 years with major lymphoma subtypes: a Nordic Lymphoma Group study

Clinical characteristics and outcomes among 2347 patients aged ≥85 years with major lymphoma subtypes: a Nordic Lymphoma Group study

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

Outcome and determinants of failure to complete primary R‐CHOP treatment for reasons other than non‐response among patients with diffuse large B‐cell lymphoma

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