Among patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), one-third are aged 70 years or older. Although chemoimmunotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard first-line therapy for DLBCL, the treatment plans for elderly patients are diverse and their outcomes are not well researched. A study presented at the 2023 ASH Annual Meeting & Exposition examined the outcomes of elderly patients with DLBCL who have been treated with varying regimens of first-line therapies, including reduced dose R-CHOP, standard dose R-CHOP, and non-anthracycline alternative regimens.

Steven Bair, MD, University of Colorado, Aurora, Colorado, and colleagues analyzed a cohort of 434 patients diagnosed with DLBCL aged 70 or older who had no history of indolent lymphoma or other cancers within the two years prior to receiving first-line therapy. The cohort data was extracted from the Flatiron Health electronic health record database, and patients’ progress was monitored using the real-world overall survival (rwOS) and real-world progression-free survival (rwPFS) indices. These involved tracking the months from DLBCL diagnosis until the latest follow-up or death, and from the start of first-line therapy until disease progression, death, or the latest follow-up, respectively. The researchers also used the Charlson comorbidity index (CCI) to draw comparisons between patient groups receiving different treatments for DLBCL.

Out of the 434 patients in the cohort, the majority received the first-line therapy, with approximately 14% having no documented therapy. The median age for the cohort was 79, and gender distribution was almost equally spread. Of the patients that received first-line therapy, nearly half were administered R-CHOP. Various doses and alternative regimens were evaluated, showing that complete response to first-line treatment was highest among patients who received the standard dose R-CHOP.

In addition, patients who received standard dose R-CHOP had better rwOS and rwPFS rates compared to those who received reduced dose or alternative regimen. There were also significant associations between improved rwPFS and rwOS rates for patients aged 70-79 who had been administered standard dose R-CHOP. Treatment intensity, however, had no noticeable effect on either rwPFS or rwOS among patients aged 80 or more, underscoring different dynamics in management of DLBCL in elderly patients.

The study found that standard dose R-CHOP is associated with improved rwPFS and rwOS compared to reduced dose R-CHOP and non-anthracycline alternative regimens in elderly patients with DLBCL, but only for the age group of 70-79. In patients aged 80 and above, the intensity or type of treatment did not significantly influence their rwPFS or rwOS. Other factors linked with the outcomes included the CCI among patients aged 80 or above, and high-risk international prognostic index in patients aged 70-79. This suggests that standard dose R-CHOP should be considered for patients aged 70-79 where possible. However, treatment intensity is not the critical driving factor of outcomes in patients aged 80 or above. Also, the CCI should be routinely included when evaluating elderly patients with DLBCL.

Bair SM, Narkhede M, Frosch ZAK, et al. Treatment intensity and outcomes in elderly patients with DLBCL receiving first Line therapy. Presented at: the 2023 ASH Annual Meeting & Exposition; December 9-12, 2023; San Diego, CA, and virtual; Abstract 68.