In a nutshell
This study evaluated the safety and effectiveness of first-line (primary treatment) BR (bendamustine, rituximab) in frail elderly patients with diffuse large B-cell lymphoma (DLBCL). This study concluded that the BR treatment showed promising effectiveness in these patients.
Some background
DLBCL is the most common type of non-Hodgkin’s lymphoma. 50% of patients with DLBCL are older than 65. For elderly patients up to 80 years of age, R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) remains the current standard of care. However, some elderly patients cannot receive the full dose of this treatment due to age or additional medical conditions.
For these patients, less toxic regimens are recommended. Previous studies have shown that the BR regimen has promising results in elderly patients with DLBCL who were not eligible for standard R-CHOP. The safety and effectiveness of the BR regimen in frail patients remains under investigation.
Methods & findings
This study involved 45 previously untreated elderly patients with DLBCL. 62.2% of patients had stage 3 – 4 disease. 80% of patients had high-risk disease. All patients received treatment with BR. Patients were followed-up for an average of 33 months.
Overall, 62% of patients responded to treatment. 53% of patients achieved complete remission (disappearance of all signs of cancer). 28.9% of patients had disease progression.
The average progression-free survival (PFS; time following treatment before the disease progresses) was 10 months. The 2-year PFS (patients without disease progression after 2 years) was 38%. The average overall survival (OS; total time patients diagnosed with the disease are still alive) was 30 months. 2-year OS (patients still alive 2 years later) was 51%.
The most common side effects reported were low white blood cell count (64.4%), low red blood cell count (44.4%), infections (20%) and low white blood cell count with fever (6.7%). 51.1% of patients experienced severe or life-threatening side effects. The most common of these included low white blood cell count (37.8%) and infections (4.44%). 60% of patients stopped treatment early due to progressive disease (26.7%) or side effects (17.8%).
The bottom line
This study concluded that the BR regimen is a good option for the treatment of frail elderly patients with DLBCL, especially when given at low doses.
The fine print
This study received funding support from Mundipharma Pharmaceuticals. This company provided bendamustine (Levact) for free for the patients in this study.
The patient population in this study was quite small. Larger studies are needed to confirm these results.
What’s next?
If you are above 70 years of age and are not eligible for R-CHOP, talk to your medical care team about the BR regimen.
Published By :
Haematologica
Date :
May 10, 2018
