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Feasibility, efficacy and safety of CHOP‐14 in elderly patients with very high‐risk diffuse large B‐cell lymphoma
Author(s) -
Tholstrup Dorte,
De Nully Brown Peter,
Jurlander Jesper,
Hansen Mads
Publication year - 2007
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2007.00877.x
Subject(s) - medicine , cohort , vincristine , regimen , diffuse large b cell lymphoma , chop , surgery , lymphoma , pediatrics , gastroenterology , chemotherapy , cyclophosphamide
Objectives: The dose‐dense CHOP‐14 regimen is efficient and safe in elderly patients with diffuse large B‐cell lymphoma (DLBCL). However, no clinical data regarding very high‐risk patients [age >75 yr and/or performance status (PS) >3] are available. The objective of this study was to evaluate the feasibility, efficacy and safety of CHOP‐14 in these patients not eligible for clinical trials. Methods: We analyzed 65 patients treated with CHOP‐14. Patients were stratified into two cohorts; A: very high‐risk (age 60–75 with PS = 4 or age >75; n = 24) and B: standard risk (age 60–75 with PS ≤3 or age <60; n = 41). Results: Fifty eight percent in cohort A achieved complete response (CR) compared with 80% in cohort B ( P = 0.054). The 3‐yr event free survival (EFS) was 40% vs. 52% (ns), 3‐yr overall survival (OAS) 44% vs. 68% ( P = 0.017). Median schedule‐erosion was 14 (0–67) (A) vs. 8 (0–44) (B) days (ns) and dose‐erosion was confined to vincristine‐reduction in both cohorts. Therapy‐associated deaths did not differ. However, a significant increase in hospital admission was found in cohort A, where 88% required hospitalization (median 47 d) compared with 68% (median 9 d) in cohort B ( P = 0.003). The patients presented with a combination of opportunistic infections, malnutrition and decreasing PS. Conclusions: Although the 3‐yr OAS in very high‐risk DLBCL is encouraging, the high frequency of severe toxicity with infections and malnutrition responsible for increased morbidity during treatment, warrants for careful attention to these very high‐risk patients.