Comorbidity is an independent prognostic factor in patients with advanced‐stage diffuse large B ‐cell lymphoma treated with R ‐ CHOP : a population‐based cohort study

Summary An observational population‐based cohort study was performed to investigate the role of comorbidity on outcome and treatment‐related toxicity in patients with newly diagnosed advanced‐stage diffuse large B ‐cell lymphoma ( DLBCL ) treated with R‐ CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Data for the clinical characteristics of 154 patients (median age 69 years), including C harlson C omorbidity I ndex ( CCI ), treatment, toxicity and outcome were evaluated. Forty‐five percent of the patients had an International Prognistic index ≥3 and 16% had a CCI ≥2. The planned R ‐ CHOP schedule was completed by 84% and 75% reached complete remission ( CR ). In those with CCI ≥2, 67% completed treatment with 46% CR . In patients with a CCI <2, overall survival ( OS ) after 1, 2 and 5 years was 84%, 79% and 65% respectively and it was 64%, 48% and 48% for those with CCI ≥2. Grade III/IV toxicity was documented in 53%, most frequently febrile neutropenia (27%) and infections (23%). In multivariate analysis CCI ≥2 and IPI ≥3 were independent risk indicators for OS and grade III / IV toxicity. In conclusion, comorbidity is an independent risk indicator for worse OS in patients with advanced DLBCL treated with R‐ CHOP by interference with intensive treatment schedules and more grade III/IV toxicity. Future studies are warranted to determine the optimal treatment approach in patients with significant comorbidities.