A real-world study of first-line therapy in 280 consecutive Swedish patients ≥80 years with newly diagnosed diffuse large B-cell lymphoma: very elderly (≥85 years) do well on curative intended therapy

Abstract

This real-world study investigated outcome of first-line treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL). All (n = 292) new DLBCL patients ≥80 years diagnosed in the Stockholm region from 2000–2015 were included. Median age was 85 years, most had good performance status and low comorbidity score. CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) was used in 60/230 patients, R-CHOP in 170/230. Only 12% of patients aged 80–84 years and 6% of ≥85 years received full-dose chemotherapy. Infections (≥ grade III) occurred in 49% and 37% in the two age groups, respectively. Addition of rituximab resulted in a similar and significant improvement in both age subsets regarding complete remission, progression-free (PFS) and overall survival (OS). Rituximab, performance status and stage, but not age, were significantly associated with PFS and OS by multivariate analysis. Strictly consecutive patients ≥85 years from a well-defined geographical region responded to and tolerated R-CHOP equally well as patients aged 80–84 years.

Keywords:

• DLBCL
• elderly
• first line therapy
• real-world

Acknowledgements

The authors thank Ms. Leila Relander for editorial assistance.

Disclosure statement

LH has received research grant support from Gilead and Janssen-Cilag. AÖ has received research grant from Abbvie, Gilead, Celgene and Janssen-Cilag. The other authors report no conflict of interest.

Author contributions

AA, SE-S, AÖ and LH designed the study, analyzed the results and wrote the draft manuscript. HJ performed the statistical analyses and wrote the statistical part of the manuscript. AA, AM and MW audited the medical files and completed the CRFs for included patients. All authors interpreted the results, reviewed and approved the manuscript.

Additional information

Funding

This study was supported by grants from AFA Insurance (Ref no: 130054), the Stockholm County Council (SLL/ALF) (Ref no: 20150070), Dr Åke Olsson Foundation for hematology research (Ref no: 2017-00426), SLL/KI Högre klinisk forskare 2018/2019 (K2894-2016), The Swedish Cancer Society (Ref no: 150930, 160534), the Cancer and Allergy Foundation, The Cancer Society in Stockholm, and the King Gustaf V Jubilee Fund, Felix Mindus Foundation and the Karolinska Institutet Foundations.