Anthracycline-Based Therapy Best for Elderly DLBCL Patients

Results of a single-center analysis indicated that patients aged 80 or older with diffuse large B-cell lymphoma (DLBCL) had superior outcomes with anthracycline-based therapies, reinforcing data found in previous clinical studies.

In fact, that survival rates found in older patients in this study treated with anthracycline-based regimens were similar to the survival seen in younger patients treated with these regimens.

“Our findings suggest that elderly patients with limited comorbidities and a good performance status should be offered standard anthracycline-based therapies with curative intent for de novo DLBCL,” researcher Dai Chihara, MD, PhD, of the University of Texas MD Anderson Cancer Center, and colleagues wrote in Cancer.

According to the study, more and more elderly people are being diagnosed with DLBCL, but few data exist about how to best manage these patients. Chihara and colleagues examined information on 207 patients aged 80 or older diagnosed with DLBCL from MD Anderson Cancer Center between 2002 and 2014. The median age of the patients was 83. More than one-half of patients had intermediate- to high-risk or high-risk International Prognostic Index scores.

For this group of patients, 70% had frontline treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); 6% had treatment with rituximab, etoposide, prednisone, vincristine, and cyclophosphamide (R-EPOCH); 6% had treatment with the non-anthracycline–based regimen rituximab, cyclophosphamide, etoposide, vincristine, and prednisone (R-CEOP) and 3% with the non-anthracycline–based regimen of rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP). The remaining patients either did not undergo treatment because of performance status, or received other treatments.

At a median follow-up of more than 3 years, 88 patients had disease progression, of which only three had relapse beyond 3 years. The 3-year overall survival rate was 54% and the failure free survival rate was 55%.

In comparing outcomes by treatment group, the researchers found that the 3-year failure-free survival rates were better for the patients who received R-CHOP (63%) or R-EPOCH (74%) compared with R-CEOP or R-CVP (23%). Three-year overall survival rates were also higher in patients who received R-CHOP (62%) or R-EPOCH (73%) compared with the non-anthracycline–based regimens (25%).

“These outcomes are comparable to those reported for younger patients with similar regimens and are nearly identical to the overall survival rates for this cohort of patients; this suggests concern about competing risks of death should not outweigh the risk of death from DLBCL in patients older than 80 years,” the researchers wrote.

Multivariate analyses looking for prognostic factors associated with improved outcomes showed that male sex (hazard ratio [HR], 1.89; P = .016), a Charlson Comorbidity Index score of 4 or more (HR, 2.17; P = .040), and an absolute monocyte count of 500 × 10⁹ or greater (HR, 1.67; P = .046) were all independently associated with a shorter overall survival among this group of patients.

Thirteen patients had treatment-related mortality after R-CHOP, two after R-CEOP or R-CVP, and two after R-EPOCH. The researchers noted that most of the deaths were due to infection with no significant difference by treatment group.

“Supportive therapy such as granulocyte colony-stimulating factor is very important in this age group, as is the management of infection,” the researchers wrote. “Patient education and close monitoring during the treatment are imperative for preventing treatment-related mortality.”