Findings from a single-center analysis have shown that anthracycline-based therapies may produce better outcomes in patients age 80 years and older with diffuse large B-cell lymphoma (DLBCL), supporting data reported in previous clinical trials.
In a study published in Cancer, researchers led by Dai Chihara, MD, PhD, University of Texas MD Anderson Cancer Center (Houston, TX), examined the treatment patterns of more than 200 patients age 80 years and older diagnosed with DLBCL at MD Anderson Cancer Center between 2002 and 2014. The median age of the patients was 83 and more than half had intermediate- to high-risk or high-risk International Prognostic Index scores.
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Of the 207 patients included in the study, 70% received first-line treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP); 6% had treatment with rituximab, etoposide, prednisone, vincristine, and cyclophosphamide (R-EPOCH); 6% had treatment with non-anthracycline rituximab, cyclophosphamide, etoposide, vincristine, and prednisone (R-CEOP); and 3% with rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP). The remaining patients either did not undergo treatment due to performance status or received other treatments.
At 3 years follow-up, 88 patients had disease progression and the 3-year overall survival and failure free survival rates were 54% and 55%, respectively. However, the failure-free rate was greatest in those who received R-EPOCH (74%) and R-CHOP (63%), followed by R-CEOP and R-CVP (23%). Three-year survival rates were also longer in those who received R-CHOP (62%) or R-EPOCH (73%) compared with the non-anthracycline–based regimens (25%).
However, 13 patients in the R-CHOP group had treatment-related morality while only 2 such events occurred in each of the other treatment groups—though researchers did note that most deaths were related to infection and not any significant difference related to the treatments themselves.
Multivariate analyses also revealed that male sex, a Charlson Comorbidity Index Score of 4 or more, and an absolute monocyte count of 500 × 109 or greater were all indicators of shorter overall survival among those included in the study.
From these results, researchers concluded that anthracycline-based regimens such as R-CHOP and R-EPOCH may provide better outcomes for elderly patients with DLBCL, similar to those achieved for younger patients with the disease.
