Tailored therapy in an unselected population of 91 elderly patients with DLBCL prospectively evaluated using a simplified CGA

Attilio Olivieri, Guido Gini, Caterina Bocci, Mauro Montanari, Silvia Trappolini, Jacopo Olivieri, Marino Brunori, Massimo Catarini, Barbara Guiducci, Alessandro Isidori, Francesco Alesiani, Luciano Giuliodori, Massimo Marcellini, Giuseppe Visani, Antonella Poloni, Pietro Leoni

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)663-672
Number of pages10
JournalThe oncologist
Volume17
Issue number5
DOIs
Publication statusPublished - 2012

Keywords

  • CGA
  • DLBCL
  • Elderly patients
  • R-CHOP

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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