TY - JOUR
T1 - Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell Lymphoma
AU - Spina, Michele
AU - Balzarotti, Monica
AU - Uziel, Lilj
AU - Ferreri, Andrés José Marìa
AU - Fratino, Lucia
AU - Magagnoli, Massimo
AU - Talamini, Renato
AU - Giacalone, Annalisa
AU - Ravaioli, Elena
AU - Chimienti, Emanuela
AU - Berretta, Massimiliano
AU - Lleshi, Arben
AU - Santoro, Armando
AU - Tirelli, Umberto
PY - 2012
Y1 - 2012
N2 - Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or deescalate therapy, thereby reducing toxicity, with consequent risks for under- or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B-cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores. Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow-up of 64 months, 51 patients were alive, with 5-year disease-free, overall, and causespecific survival rates of 80%, 60%, and 74%, respectively. Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA-driven treatment may result in better cure rates, especially in fit and unfit patients.
AB - Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or deescalate therapy, thereby reducing toxicity, with consequent risks for under- or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B-cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores. Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow-up of 64 months, 51 patients were alive, with 5-year disease-free, overall, and causespecific survival rates of 80%, 60%, and 74%, respectively. Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA-driven treatment may result in better cure rates, especially in fit and unfit patients.
KW - Comprehensive geriatric assessment
KW - Elderly
KW - Non-Hodgkin's lymphoma
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=84862840453&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862840453&partnerID=8YFLogxK
U2 - 10.1634/theoncologist.2011-0417
DO - 10.1634/theoncologist.2011-0417
M3 - Article
C2 - 22610154
AN - SCOPUS:84862840453
VL - 17
SP - 838
EP - 846
JO - Oncologist
JF - Oncologist
SN - 1083-7159
IS - 6
ER -