Aggressive lymphomas of the elderly: the DEVEC metronomic chemotherapy schedule fits the unfit

Rituximab Plus Chemotherapy Provides No Clinical Benefit in a Peripheral T-Cell Lymphoma not Otherwise Specified with Aberrant Expression of CD20 and CD79a: A Case Report and Review of the Literature

“…Patients who respond to second-line therapies, if suitable, should be addressed to allotransplant [57]. Lastly, as the majority of patients with CD20+ PTCL were ≥70 years old, the all-oral metronomic DEVEC (Deltacortene®, etoposide, vinorelbine, cyclophosphamide) schedule may also be considered as a convenient approach for elderly and vulnerable patients [58].…”

Impact of therapeutic management and geriatric evaluation on patient of eighty years and older with diffuse large B‐cell lymphoma on survival: A systematic review

“…The R‐IFOSFAMIDE‐etoposide (R‐IE) protocol followed by 2 cycles of rituximab also appears to be an interesting alternative: In a phase II trial of 30 patients aged 60 and over, with relapsed/refractory diseases and not eligible for therapeutic intensification, a CR of 55%, with an ORR of 76%, and a median OS of 24 months were observed 58 . A few small studies have also evaluated the association of lenalidomide with rituximab, with an ORR of 33% in Wang et al study, 59 and an ORR of 35% in the study of Zinzani et al 60 Finally, in a prospective study with DEVEC oral chemotherapy, among 45 patients with aggressive B and T lymphomas, including 78% patients with refractory or relapsed disease, CR rate was 34.9% with a median survival of 13 months 61 …”

“…58 A few small studies have also evaluated the association of lenalidomide with rituximab, with an ORR of 33% in Wang et al study, 59 and an ORR of 35% in the study of Zinzani et al 60 Finally, in a prospective study with DEVEC oral chemotherapy, among 45 patients with aggressive B and T lymphomas, including 78% patients with refractory or relapsed disease, CR rate was 34.9% with a median survival of 13 months. 61…”

Metronomic Chemotherapy in Elderly Patients

“…Control group ORR: 38.1% (2 CR and 6 PR), DCR: 57.1% (2 CR, 6 PR and 4 SD) During the 12-month follow-up, test group ORR: 47.8% (3 CR and 8 PR), DCR: 69.6% (3 CR, 8 PR and 5 SD). ORR control group: 19.0% (1 and CR and 3 PR), DCR:33.3% (1 CR, 3 PR and 3 SD) No grade 3/4/5 adverse effects and no toxicity-related deaths reported in either group Zeng et al [ 61 ] Diffuse large B- and T- cell lymphomas 55 DEVEC Median age 80 years old (range 56–93) Median OS: 13 months; PFS:11 months 22.2% of G ≥ 3 extra hematological adverse events (7 neutropenic fever or infection requiring hospitalization, 1 pulmonary embolism, 1 heart failure, and 1 multi organ failure); 1 of these patients died; 4 discontinued treatment During the induction phase, 60% of patients had neutropenia ≥ G3 and 4.4% had anemia ≥ G3 Cox et al[ 57 ••] Diffuse large B-cell Lymphoma 51 DEVEC Frail ≥ 65 years or ineligible ≥ 85 years; R/R ≥ 55 years; median age 85 years naive patients (range 77–93), R/R patients 78 years (range 57–91) OS and PFS at one year were 67% and 61% for DEVEC-naïve, 60% and 50% for reference-naïve; OS, PFS and FFS at one year: 67%, 61% and 55% for DEVEC-naïve, 60%, 50% and 50% for reference-naïve, respectively 43% hematologic adverse events of G ≥ 3 (G3 neutropenia was the most frequent); 13.7% extra hematologic adverse events of grade ≥ 3 (infection was the most frequent). 5.9% severe hematologic toxicity events (grade 4 cytopenia lasting more than 6 days) in heavily pretreated patients or those with bone marrow involvement Cox et al[ 65 ] Diffuse large B-cell Lymphoma 22 DEVEC Mean age 84.5 years At the mid-term evaluation, ORR and CRR were 77% and 32%, respectively, while at the end of induction the ORR and CRR were both 64%.…”