Tailored Therapy in an Unselected Population of 91 Elderly Patients with DLBCL Prospectively Evaluated Using a Simplified CGA

• Published in: The oncologist (Dayton, Ohio) Vol. 17; no. 5; pp. 663 - 672
• Main Authors: Olivieri, Attilio, Gini, Guido, Bocci, Caterina, Montanari, Mauro, Trappolini, Silvia, Olivieri, Jacopo, Brunori, Marino, Catarini, Massimo, Guiducci, Barbara, Isidori, Alessandro, Alesiani, Francesco, Giuliodori, Luciano, Marcellini, Massimo, Visani, Giuseppe, Poloni, Antonella, Leoni, Pietro
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.05.2012
• Subjects: Age Factors; Aged; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; CGA; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Disease-Free Survival; DLBCL; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Elderly patients; Female; Geriatric Assessment; Geriatric Oncology; Humans; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - pathology; Male; Prednisolone - administration & dosage; Prednisolone - adverse effects; Prednisone - administration & dosage; Prednisone - adverse effects; Prospective Studies; Rituximab; R‐CHOP; Treatment Outcome; Vincristine - administration & dosage; Vincristine - adverse effects
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2011-0355

Learning Objectives: After completing this course, the reader will be able to: Demonstrate the proper use of a simplified comprehensive geriatric analysis, including activities of daily living (ADL), Mini‐Mental State Evaluation (MMSE), Cumulative Illness Rating Scale–Geriatrics (CIRS‐G), and geriatric syndromes (multidimensional geriatric assessment [MGA]). Maintaining a tailored anthracycline‐based therapy, describe alternative treatment in elderly diffuse large B‐cell lymphoma (DLBCL) patients unfit for the standard chemotherapy. This article is available for continuing medical education credit at CME.TheOncologist.com Background. Elderly patients with diffuse large B‐cell lymphoma (DLBCL) are a heterogeneous population; clinical trials have evaluated a minority of these patients. Patients and Methods. Ninety‐one elderly patients with DLBCL received tailored treatment based on a comprehensive geriatric assessment (CGA). Three groups were identified: I, fit patients; II, patients with comorbidities; III, frail patients. Group I received 21‐day cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP‐21), group II received R‐CHOP‐21 with liposomal doxorubicin, and group III received 21‐day cycles of reduced‐dose CHOP. Fifty‐four patients (59%) were allocated to group I, 22 (25%) were allocated to group II, and 15 (16%) were allocated to group III. Results. The complete response (CR) rates were 81.5% in group I, 64% in group II, and 60% in group III. With a median follow‐up of 57 months, 42 patients are alive, with 41 in continuous CR: 31 patients (57%) in group I, seven patients (32%) in group II, and four patients (20%) in group III. The 5‐year overall survival, event‐free survival, and disease‐free survival rates in all patients were 46%, 31%, and 41%, respectively. Multivariate analysis selected group I assignment as the main significant prognostic factor for outcome. Conclusions. This approach in an unselected population of elderly DLBCL patients shows that treatment tailored according to a CGA allows the evaluation of elderly patients who are currently excluded from clinical trials. Ninety‐one elderly patients with diffuse large B‐cell lymphoma were given tailored treatment based on the results of a comprehensive geriatric assessment. Treatment was feasible with encouraging outcomes.