Cancer Res Treat.  2018 Apr;50(2):590-598. 10.4143/crt.2017.172.

Multicenter Retrospective Analysis of Clinical Characteristics, Treatment Patterns, and Outcomes in Very Elderly Patients with Diffuse Large B-Cell Lymphoma: The Korean Cancer Study Group LY16-01

Affiliations
  • 1Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea. jhcmd@hanyang.ac.kr
  • 2Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
  • 4Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.
  • 5Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Korea Institute of Radiological and Medical Sciences, Korea Cancer Center Hospital, Seoul, Korea.
  • 7Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 8Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.
  • 9Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 10Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
  • 11Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
  • 12Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
  • 13Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
  • 14Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea.
  • 15Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
  • 16Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea.
  • 17Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
  • 18Devision of Hematology-Oncology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
  • 19Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Abstract

PURPOSE
The treatment strategy for elderly patients older than 80 years with diffuse large B-cell lymphoma (DLBCL) has not been established because of poor treatment tolerability and lack of data.
MATERIALS AND METHODS
This multicenter retrospective study was conducted to investigate clinical characteristics, treatment patterns and outcomes of patients older than 80 years who were diagnosed with DLBCL at 19 institutions in Korea between 2005 and 2016.
RESULTS
A total of 194 patients were identified (median age, 83.3 years). Of these, 114 patients had an age-adjusted International Prognostic Index (aaIPI) score of 2-3 and 48 had a Charlson index score of 4 or more. R-CHOP was given in 124 cases, R-CVP in 13 cases, other chemotherapy in 17 cases, radiation alone in nine cases, and surgery alone in two cases. Twenty-nine patients did not undergo any treatment. The median number of chemotherapy cycles was three. Only 37 patients completed the planned treatment cycles. The overall response rate from 105 evaluable patients was 90.5% (complete response, 41.9%). Twentynine patients died due to treatment-related toxicities (TRT). Thirteen patients died due to TRT after the first cycle. Median overall survival was 14.0 months. The main causes of death were disease progression (30.8%) and TRT (27.1%). In multivariate analysis, overall survival was affected by aaIPI, hypoalbuminemia, elevated creatinine, and treatment.
CONCLUSION
Age itself should not be a contraindication to treatment. However, since elderly patients show higher rates of TRT due to infection, careful monitoring and dose modification of chemotherapeutic agents is needed.

Keyword

Diffuse large B-cell lymphoma; Aged; Infection

MeSH Terms

Aged*
B-Lymphocytes*
Cause of Death
Creatinine
Disease Progression
Drug Therapy
Humans
Hypoalbuminemia
Korea
Lymphoma, B-Cell*
Multivariate Analysis
Retrospective Studies*
Creatinine

Figure

  • Fig. 1. Diagram of treatment and response for the patients who received chemotherapy. R-CHOP, rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone; NE, not evaluable; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease.

  • Fig. 2. Kaplan-Meier plots of overall survival in 194 patients (A) and according to treatment (B). Overall survival in 154 patients who received chemotherapy according to treatment regimen (C) and number of chemotherapy cycles (D).


Reference

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