Can Elderly Patients With DLBCL Tolerate Standard Treatment?

July 10, 2018

The OS benefit associated with standard treatment diminished in patients older than 80 with high comorbidity scores, but other age groups fared better.

The majority of patients with diffuse large B-cell lymphoma (DLBCL) aged 75 or older had good outcomes when undergoing standard treatment for their disease, according to a study published in the European Journal of Cancer.

Due to the retrospective nature of the study, Maja Bech Juul, Odense University Hospital, Odense, Denmark, and colleagues commented that they were “cautious in making recommendations that are too firm.”

The median age at diagnosis of DLBCL is 70, making it primarily a disease of the elderly, the investigators noted. A standard regimen of R-CHOP (rituximab plus cyclophosphamide, doxorubicin, and vincristine) cures up to 70% of elderly patients with DLBCL included in clinical trials. However, these patients often meet strict inclusion criteria that do not reflect real-world populations.

With this study, Juul and colleagues looked at age-specific group outcomes, including the effects of comorbidities.

Using the Danish National Lymphoma Registry, the researchers identified all Danish patients with DLBCL aged 75 or older diagnosed between 2003 and 2012. The 1,011 patients included in the trial were stratified by age (75–79 years, 80–84 years, and 85 and older).

Overall, 64% of patients underwent standard treatment with R-CHOP or a CHOP-like treatment regimen. Specifically, 83% of patients 75 to 79 years of age underwent standard treatment, whereas only 32% of patients aged 85 and older did. Half of the patients older than 85 received palliative treatment only.

Undergoing standard treatment was associated with a median overall survival (OS) of 4.6 years, 2.6 years, and 1.9 years for patients in the 75 to 79, 80 to 84, and 85 and older age groups, respectively. Median progression-free survival (PFS) outcomes were similar to OS in all three groups. In patients 85 and older, there was no significant difference in OS between patients that received standard treatment compared with a less intensive regimen.

“Among patients aged 75 to 79 years, overall survival seemed higher in patients receiving standard treatment regardless of comorbidity, while the overall survival benefit associated with standard treatment diminished in patients older than 80 years with high comorbidity scores,” the researchers wrote.

In patients younger than 85, the risk for death was higher in patients who underwent less-intensive treatment rather than standard treatment. The 30-day mortality was 3.4% in patients who received standard therapy, compared with 2.8% in patients on less-intensive treatment. The researchers noted that the majority of patients were hospitalized within the first week after diagnosis, regardless of treatment group.

“Patients alive at 2 years after end of treatment have a low risk of death from lymphoma,” the researchers wrote. “However, the incidence of non-lymphoma deaths is inevitably high in this old age group.”

During the follow-up period, the majority of patients (78%) died. The 3-year cumulative incidence of lymphoma-related death was 0.22, 0.31, and 0.31, respectively, across the three age groups examined and treated with standard therapy. For those treated with less intensive therapy, these incidences were 0.38, 0.34, and 0.26.