Disease characteristics, patterns of care, and survival in very elderly patients with diffuse large B‐cell lymphoma

Abstract

Background Although rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered standard therapy for diffuse large B-cell lymphoma (DLBCL), patterns of use and the impact of R-CHOP on survival in patients >80 years are less clear. Methods We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to characterize presentation, treatment, and survival patterns in DLBCL patients diagnosed from 2002–2009. Chi-squared tests compared characteristics and initial treatments of DLBCL patients >80 years and ≤80 years. Multivariable logistic regression models examined factors associated with treatment selection in patients >80 years; standard and propensity score-adjusted multivariable Cox proportional hazards models examined relationships between treatment regimen, treatment duration, and survival. Results Among 4,635 patients with DLBCL, 1,156 (25%) were >80 years. Patients >80 were less likely to receive R-CHOP and more likely to be observed or receive rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP); both p<0.0001. Marital status, stage, disease site, performance status, radiation therapy, and growth factor support were associated with initial R-CHOP in patients >80. In propensity score-matched multivariable Cox proportional hazards models examining relationships between treatment regimen and survival, R-CHOP was the only regimen associated with improved OS (hazard ratio (HR) = 0.45, 95% confidence interval (CI) = 0.33–0.62) and LRS (HR=0.58, 95% CI 0.38–0.88). Conclusions Although DLBCL patients >80 years were less likely to receive R-CHOP, this regimen conferred the longest survival and should be considered for this population. Further studies are needed to characterize the impact of DLBCL treatment on quality of life in this age group.

Management strategies and outcomes for very elderly patients with diffuse large B‐cell lymphoma

“…In this large cohort of very elderly patients with DLBCL, we examined baseline clinical characteristics that were associated with treatment selection and outcomes after the most common frontline management strategies used at our institution. We report favorable outcomes after anthracycline‐based therapies, and this finding is consistent with previous studies . To examine the impact of frontline therapy in this unique population, we excluded competing risks of death, and we report the 3‐year FFS rates for those who received R‐EPOCH, R‐CHOP, and R‐CEOP or R‐CVP to be 74%, 63%, and 23%, respectively.…”

Role of anthracycline and comprehensive geriatric assessment for elderly patients with diffuse large B-cell lymphoma

“…Fifteen studies conducted between 2010 and 2016 fulfilled the inclusion criteria, including 9 retrospective cohort studies [20][21][22][23][24][25][26][27][28] and 2 administrative database-derived epidemiologic studies 29,30 comparing chemotherapy regimens with or without anthracyclines in elderly patients who had newly diagnosed DLBCL (Table 1). No randomized For personal use only.…”

Population-specific prognostic models are needed to stratify outcomes for African-Americans with diffuse large B-cell lymphoma

“…Studies have identified that men and women treated with rituximab-based therapies may have different outcomes [58,59]. It has also been shown that elderly patients (age greater than 70) with DLBCL are not well stratified using the IPI system [20]. Large cohorts of DLBCL patients assembled through epidemiologic studies or clinical trials are needed to assess the value of the IPI and novel prognostic scoring systems that permit inclusion of these and other demographic factors in prognostic models.…”

“…We used the third edition of the International Classification of Diseases for Oncology (ICD-O-3) to identify DLBCL cases in SEER, including codes 9680 (DLBCL), 9679 (primary mediastinal large B-cell lymphoma), 9684 (immunoblastic large B-cell lymphoma), and 9678 (primary effusion lymphoma), in line with the case identification approach in prior analyses [12]. We restricted to the data after 2002, which represents the rituximab era, the standard of care of DLBCL patients transitioned to the use of first-line immunochemotherapy (R-CHOP) after that time point and improved observed outcomes [18-20]. All cases had known age at diagnosis ≥18 and race coded as white or black (used to identify AA patients for this study) in SEER.…”