Learning Objectives:
After completing this course, the reader will be able to:
Demonstrate the proper use of a simplified comprehensive geriatric analysis, including activities of daily living (ADL), Mini‐Mental State Evaluation (MMSE), Cumulative Illness Rating Scale–Geriatrics (CIRS‐G), and geriatric syndromes (multidimensional geriatric assessment [MGA]).
Maintaining a tailored anthracycline‐based therapy, describe alternative treatment in elderly diffuse large B‐cell lymphoma (DLBCL) patients unfit for the standard chemotherapy.
This article is available for continuing medical education credit at http://CME.TheOncologist.com
Background.
Elderly patients with diffuse large B‐cell lymphoma (DLBCL) are a heterogeneous population; clinical trials have evaluated a minority of these patients.
Patients and Methods.
Ninety‐one elderly patients with DLBCL received tailored treatment based on a comprehensive geriatric assessment (CGA). Three groups were identified: I, fit patients; II, patients with comorbidities; III, frail patients. Group I received 21‐day cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP‐21), group II received R‐CHOP‐21 with liposomal doxorubicin, and group III received 21‐day cycles of reduced‐dose CHOP. Fifty‐four patients (59%) were allocated to group I, 22 (25%) were allocated to group II, and 15 (16%) were allocated to group III.
Results.
The complete response (CR) rates were 81.5% in group I, 64% in group II, and 60% in group III. With a median follow‐up of 57 months, 42 patients are alive, with 41 in continuous CR: 31 patients (57%) in group I, seven patients (32%) in group II, and four patients (20%) in group III. The 5‐year overall survival, event‐free survival, and disease‐free survival rates in all patients were 46%, 31%, and 41%, respectively. Multivariate analysis selected group I assignment as the main significant prognostic factor for outcome.
Conclusions.
This approach in an unselected population of elderly DLBCL patients shows that treatment tailored according to a CGA allows the evaluation of elderly patients who are currently excluded from clinical trials.