Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: An Australian retrospective analysis

Millar, A., Ellis, M., Mollee, P., Cochrane, T., Fletcher, J., Caudron, A., Webster, B. and Trotman, J. (2015) Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: An Australian retrospective analysis. Internal Medicine Journal, 45 11: 1147-1153. doi:10.1111/imj.12889


Author Millar, A.
Ellis, M.
Mollee, P.
Cochrane, T.
Fletcher, J.
Caudron, A.
Webster, B.
Trotman, J.
Title Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: An Australian retrospective analysis
Journal name Internal Medicine Journal   Check publisher's open access policy
ISSN 1444-0903
1445-5994
Publication date 2015-11-01
Year available 2015
Sub-type Article (original research)
DOI 10.1111/imj.12889
Open Access Status Not Open Access
Volume 45
Issue 11
Start page 1147
End page 1153
Total pages 7
Place of publication Richmond, VIC Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Formatted abstract
Background
Elderly patients with diffuse large B-cell lymphoma (DLBCL) have an inferior prognosis, due in part to advanced age and pre-existing comorbidities, with reduced tolerability and deliverability of standard R-CHOP chemotherapy.

Aims
To examine the deliverability, toxicity and efficacy of R-CHOP and the prevalence of the germinal and non-germinal phenotype DLBCL in an elderly Australian cohort.

Methods
This retrospective analysis included patients ≥75 years diagnosed with DLBCL. Comprehensive chemotherapy and toxicity data were collected for patients treated with R-CHOP. Baseline demographics and chemotherapy characteristics were compared with progression-free (PFS) and overall survival (OS). Immunohistochemical staining identified the prevalence of the non-germinal centre (non-GCB) phenotype.

Results
Of the 111 patients, 92 (83%) commenced R-CHOP with 26/92 (28%) receiving ≤4 cycles. Median average relative dose (ARD) was 0.80 (0.07–1.17). Median average relative dose intensity (ARDI) was 0.89 (0.33–1.18). Serious adverse events occurred in 77% of patients with ≥Gd3 adverse events in 74%. Overall response rate was 85%. Two-year PFS was 63% and OS 74%. ARD and performance status ≥2 were significant prognostic factors for PFS and OS but not ARDI. Non-GCB-phenotype was identified in 44/72 (61%) of patients with immunohistochemical data.

Conclusion
Despite high response rates and respectable survival estimates, the absence of standard therapy in 17% of patients, and dose reductions and serious toxicity of R-CHOP in this Australian cohort highlights the need for the development of less toxic yet efficacious treatments for very elderly patients with DLBCL. The high prevalence of the non-GCB phenotype highlights the potential value of targeted biological therapy for this demographic.
Keyword Aged
Diffuse
Large B cell
Lymphoma
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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