Improved outcome for very elderly patients with diff use large B-cell lymphoma in the immunochemotherapy era

Abstract

The prognosis of diffuse large B-cell lymphoma (DLBCL) has improved significantly since the introduction of immunochemotherapy (rituximab [R] with cyclophosphamide, doxorubicin, vincristine, prednisone [CHOP]). However, few outcome data are available for very elderly patients (80 years). Therefore, we compared all patients with DLBCL aged 80 years diagnosed in the Gothenburg area during two time periods (2006–2009, “post-R” and 1997–2000, “pre-R”). Forty and 30 patients were identified, corresponding to 23.5% and 20.5%, respectively, of the entire population with DLBCL. Estimated 3-year progression-free (PFS) and overall (OS) survival was better post-R than pre-R: 41% vs. 17% (p = 0.015) and 41% vs. 17% (p = 0.01), respectively. Fifty-three percent of post-R patients were treated with curative intent with a moderately reduced R-CHOP regimen (median relative dose intensity: 0.86). At a median follow-up of 29 months, the 3-year PFS and OS were 70% (p = 0.018) and 76% (p = 0.0089), respectively. In conclusion, moderately reduced R-CHOP is tolerable and effective for a considerable number of very elderly patients with DLBCL and high age by itself should not be a reason for excluding a patient with DLBCL from such treatment.

Keywords::

• Diffuse large B-cell lymphoma
• R-CHOP
• very elderly
• 80 years

Acknowledgements

This study was supported by “FoU V stra G talandsregionen” and the Swedish Medical Society.

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