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Deliverability and efficacy of R ‐ CHOP chemotherapy in very elderly patients with diffuse large B ‐cell lymphoma: an A ustralian retrospective analysis
Author(s) -
Millar A.,
Ellis M.,
Mollee P.,
Cochrane T.,
Fletcher J.,
Caudron A.,
Webster B.,
Trotman J.
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12889
Subject(s) - medicine , chop , chemotherapy , lymphoma , diffuse large b cell lymphoma , oncology
Background Elderly patients with diffuse large B ‐cell lymphoma ( DLBCL ) have an inferior prognosis, due in part to advanced age and pre‐existing comorbidities, with reduced tolerability and deliverability of standard R ‐ CHOP chemotherapy. Aims To examine the deliverability, toxicity and efficacy of R ‐ CHOP and the prevalence of the germinal and non‐germinal phenotype DLBCL in an elderly Australian cohort. Methods This retrospective analysis included patients ≥75 years diagnosed with DLBCL . Comprehensive chemotherapy and toxicity data were collected for patients treated with R ‐ CHOP . Baseline demographics and chemotherapy characteristics were compared with progression‐free ( PFS ) and overall survival ( OS ). Immunohistochemical staining identified the prevalence of the non‐germinal centre (non‐ GCB ) phenotype. Results Of the 111 patients, 92 (83%) commenced R ‐ CHOP with 26/92 (28%) receiving ≤4 cycles. Median average relative dose ( ARD ) was 0.80 (0.07–1.17). Median average relative dose intensity ( ARDI ) was 0.89 (0.33–1.18). Serious adverse events occurred in 77% of patients with ≥ G d3 adverse events in 74%. Overall response rate was 85%. Two‐year PFS was 63% and OS 74%. ARD and performance status ≥2 were significant prognostic factors for PFS and OS but not ARDI . Non‐ GCB ‐phenotype was identified in 44/72 (61%) of patients with immunohistochemical data. Conclusion Despite high response rates and respectable survival estimates, the absence of standard therapy in 17% of patients, and dose reductions and serious toxicity of R ‐ CHOP in this Australian cohort highlights the need for the development of less toxic yet efficacious treatments for very elderly patients with DLBCL . The high prevalence of the non‐ GCB phenotype highlights the potential value of targeted biological therapy for this demographic.