Open AccessTailored Therapy in an Unselected Population of 91 Elderly Patients with DLBCL Prospectively Evaluated Using a Simplified CGA
Author(s) -
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
Publication year - 2012
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2011-0355
Subject(s) - medicine , prednisone , diffuse large b cell lymphoma , vincristine , rituximab , population , anthracycline , lymphoma , oncology , surgery , cyclophosphamide , chemotherapy , cancer , environmental health , breast cancer
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.comBackground. 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.