A Fondazione Italiana Linfomi cohort study of R-COMP vs R-CHOP in older patients with diffuse large B-cell lymphoma

• Published in: Blood advances Vol. 7; no. 15; pp. 4160 - 4169
• Main Authors: Arcari, Annalisa, Rigacci, Lugi, Tucci, Alessandra, Puccini, Benedetta, Usai, Sara Veronica, Cavallo, Federica, Fabbri, Alberto, Balzarotti, Monica, Pelliccia, Sabrina, Luminari, Stefano, Pennese, Elsa, Zilioli, Vittorio Ruggero, Mahmoud, Abdurraouf Mokhtar, Musuraca, Gerardo, Marino, Dario, Sartori, Roberto, Botto, Barbara, Gini, Guido, Zanni, Manuela, Hohaus, Stefan, Tarantini, Giuseppe, Flenghi, Leonardo, Tani, Monica, Di Rocco, Alice, Merli, Michele, Vallisa, Daniele, Pagani, Chiara, Nassi, Luca, Dessì, Daniela, Ferrero, Simone, Cencini, Emanuele, Bernuzzi, Patrizia, Mammi, Caterina, Marcheselli, Luigi, Tabanelli, Valentina, Spina, Michele, Merli, Francesco
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 08.08.2023; The American Society of Hematology
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Clinical Trials and Observations; Cohort Studies; Cyclophosphamide - adverse effects; Doxorubicin - adverse effects; Heart Diseases - etiology; Humans; Lymphoma, Large B-Cell, Diffuse - pathology; Prednisone - adverse effects; Prospective Studies; Rituximab - adverse effects; Treatment Outcome; Vincristine - adverse effects
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2023009839

•R-COMP is a curative option for older patients with DLBCL and intermediate- to high-risk EPI, even in the presence of a baseline cardiopathy.•R-CHOP is confirmed as the standard therapy for patients at low risk based on the EPI. [Display omitted] Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the most commonly used regimen for the upfront treatment of diffuse large B-cell lymphoma (DLBCL). However, it is associated with cardiotoxicity, especially in older patients. Substituting doxorubicin with non-PEGylated liposomal doxorubicin (R-COMP) may reduce the risk of cardiac events, but its efficacy has never been demonstrated in prospective trials. We describe the characteristics and outcome of patients with DLBCL aged ≥65 years prospectively enrolled in the Elderly Project by the Fondazione Italiana Linfomi and treated with full doses of R-CHOP or R-COMP per local practice. Starting from 1163 patients, 383 (55%) were treated with R-CHOP and 308 (45%) with R-COMP. Patients treated with R-COMP were older (median age, 76 vs 71 years), less frequently fit at simplified geriatric assessment (61% vs 88%; P < .001), and had a more frequent baseline cardiac disorders (grade >1, 32% vs 8%; P < .001). Three-year progression-free survival (PFS) was similar between R-CHOP and R-COMP (70% and 64%); 3-year overall survival was 77%, and 71% respectively. R-CHOP was associated with better PFS vs R-COMP only in the Elderly Prognostic Index (EPI) low-risk group. The two groups had similar rates of treatment interruptions due to toxicities or of cardiac events (P = 1.00). We suggest R-COMP is a potentially curative treatment for older patients with intermediate- or high-risk EPI, even in the presence of a baseline cardiopathy. R-CHOP is confirmed as the standard therapy for low risk patients.