Comparing survival outcomes for elderly DLBCL patients receiving different first-line chemotherapies

This study investigated the effects of different chemotherapies on the survival outcomes of elderly patients with diffuse large B-cell lymphoma (DLBCL). This study concluded that R-CHOP treatment is associated with very good survival in elderly patients with DLBCL.

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), accounting for about 30% of new NHL cases in the U.S. Almost one-third of newly diagnosed patients are older than 75. The most widely used treatment for this aggressive cancer is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone).

Research has suggested that elderly DLBCL patients tend to have poorer outcomes. Comorbidities (other medical conditions) also make it difficult to administer effective dosages. Studies investigating whether R-CHOP should be used in very elderly patients (over age 80) have had mixed results. Optimal treatment strategies for these patients remains under investigation.

This study analyzed data from 252 elderly patients with DLBCL (96.4%) or follicular lymphoma (FL; 3.57%). 63% of patients received first-line chemotherapy. 43% received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone), at either full-dose (24%) or a lower dose (26%; R-CHOPr). Additional regimens included CHOP (10%; R-CHOP without rituximab), CVP (26%; cyclophosphamide, vincristine, prednisone), or R-CVP (14%; CVP with rituximab). 15% of patients did not receive any chemotherapy. 7.5% did not receive any treatment at all. The average follow-up period was 44 months.

The average PFS was 28 months (R-CHOP), 19 months (R-CHOPr), 7 months (R-CVP), 6 months (CHOP), and 4 months (CVP). The average OS was 40 months (R-CHOP), 24 months (R-CHOPr), 12 months (R-CVP), 7 months (CHOP), and 6 months (CVP). PFS in the R-CHOP or R-CHOPr groups were significantly longer than the other groups.

Overall response (OR; shrinkage or complete disappearance of tumors) rates were 75% (R-CHOP), 80% (R-CHOPr), 60% (R-CVP), 36% (CHOP), and 25.5% (CVP). 

Cancer-related mortality was significantly lower in patients who received treatment containing rituximab. This was 35% (R-CHOP), 29% (R-CHOPr), 40% (R-CVP), 64% (CHOP), and 67% (CVP).

Both R-CHOP and R-CHOPr decreased risk of disease progression by 60%. Mortality risk decreased by 50% (R-CHOP) and 60% (R-CHOPr). These were statistically significant. R-CVP decreased both of these risks by 30%. CHOP decreased both of these risks by 10%. These were not statistically significant.

In R-CHOP-treated patients, average OS was 45 months (0-1 risk factors) versus 12 months (2-3 risk factors). These risk factors included age (older than 85), high-risk disease, or multiple comorbidities.

This study concluded that R-CHOP treatment is associated with very good survival in elderly patients with DLBCL. The authors suggest that patients who may benefit from curative R-CHOP-like treatment may be selected based on certain risk factors.

This study was retrospective, meaning it looked back in time to analyze data. Risk factors were also assessed from medical records. As a result, collected data may be incomplete. This may limit the conclusions that can be drawn from these results. Larger studies are needed to further confirm these results.