Survival of very elderly patients with diffuse large B‐cell lymphoma according to treatment intensity in the immunochemotherapy era: a Swedish Lymphoma Register study

Abstract

Diffuse large B-cell lymphoma (DLBCL) incidence rises with increasing age. Rituximab-anthracycline-based regimens offer a potential cure but also risks of adverse events, especially in the elderly. Using Swedish registers, we conducted a nationwide, population-based study of DLBCL in the very elderly. We obtained information on clinical characteristics, residence, comorbidity, therapy and survival for the 1194 patients aged ≥80 years diagnosed in Sweden 2007-2014. To address selection bias, we also investigated treatment differences between Sweden's Healthcare Regions and whether there were survival differences between the Regions. The 2-year overall and relative survivals were better in patients aged ≥80 years given treatment with curative intent (54%; 64%) than low-intensity (26%; 33%), or palliative treatment (6%; 7%). The fraction of patients treated with curative intent varied between the Healthcare Regions (45-76%). Survival was significantly inferior in Regions with few patients treated with curative intent (multivariable hazard ratio 1.3, 95% confidence interval 1.1-1.6). When treatment intensity and Regions competed, Regions were no longer independent, suggesting that Regional survival differences are due to therapeutic differences. Furthermore, we found that the age-adjusted International Prognostic Index was independently associated with survival. We conclude that patients aged ≥80 years with DLBCL appear to benefit from rituximab-anthracycline-based treatment given with curative intent.

A simplified frailty score predicts survival and can aid treatment-intensity decisions in older patients with DLBCL

“…In the study by FIL, 19,47 unfit patients had similar OS following full-dose R-CHOP ($70%) and attenuated R-CHOP (,70%) but poorer survival following an anthracycline-free regimen, although the results were not adjusted for possible confounders. Registry-based and smaller retrospective studies 8,[31][32][33]50 report better outcomes with an anthracycline-containing regimen, also for older patients and for patients with comorbidity. None of these studies stratified their analyses according to frailty status.…”

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

“…In particular there was a decrease in PFS with less intensive treatments 25,29,36 . These results were recently confirmed by a large retrospective study by Sonnevi et al 47 In total, 1195 patients over 80 years old with DLBCL had an OS at 2 years of 54% in the standard curative treatment group versus 26% in the less intensive treatment group ( p < .005).…”

Triple-hit lymphoma in a 95-year-old patient: a case report and literature review

“…Chelsea et al explored incorporating consolidative radiation therapy (RT) to reduce overall chemotherapy drug exposure, they found age older than 80 years who with early-stage patients, 3 to 4 cycles of chemotherapy followed by RT of disease free survival (DFS), PFS, OS (P=0.78, P=0.654, P=0.852) were equivalent to chemotherapy alone and was associated with less toxic reaction, which suggested that RT following short chemotherapy may be a better choice for some earlystage elderly patients who could not tolerate standard course of chemotherapy [9]. A study from the Swedish Lymphoma Register showed that very elderly patients seem to bene t from rituximabanthracycline-based treatment [10]. However, most of very elderly patients are associated with an increasing risk of coronary artery diseases, the use of potentially cardiotoxic drugs such as anthracyclinebased chemotherapy may not tolerate.…”