Ninety-one elderly patients with diffuse large B-cell lymphoma were given tailored treatment based on the results of a comprehensive geriatric assessment. Treatment was feasible with encouraging outcomes.
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Demonstrate the proper use of a simplified comprehensive geriatric analysis, including activities of daily living (ADL), Mini-Mental State Evaluation (MMSE), Cumulative Illness Rating Scale–Geriatrics (CIRS-G), and geriatric syndromes (multidimensional geriatric assessment [MGA]).Maintaining a tailored anthracycline-based therapy, describe alternative treatment in elderly diffuse large B-cell lymphoma (DLBCL) patients unfit for the standard chemotherapy.
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Elderly patients with diffuse large B-cell lymphoma (DLBCL) are a heterogeneous population; clinical trials have evaluated a minority of these patients.
Patients and Methods.
Ninety-one elderly patients with DLBCL received tailored treatment based on a comprehensive geriatric assessment (CGA). Three groups were identified: I, fit patients; II, patients with comorbidities; III, frail patients. Group I received 21-day cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP-21), group II received R-CHOP-21 with liposomal doxorubicin, and group III received 21-day cycles of reduced-dose CHOP. Fifty-four patients (59%) were allocated to group I, 22 (25%) were allocated to group II, and 15 (16%) were allocated to group III.
The complete response (CR) rates were 81.5% in group I, 64% in group II, and 60% in group III. With a median follow-up of 57 months, 42 patients are alive, with 41 in continuous CR: 31 patients (57%) in group I, seven patients (32%) in group II, and four patients (20%) in group III. The 5-year overall survival, event-free survival, and disease-free survival rates in all patients were 46%, 31%, and 41%, respectively. Multivariate analysis selected group I assignment as the main significant prognostic factor for outcome.
This approach in an unselected population of elderly DLBCL patients shows that treatment tailored according to a CGA allows the evaluation of elderly patients who are currently excluded from clinical trials.