Survival of very elderly patients with diffuse large B-cell lymphoma according to treatment intensity in the immunochemotherapy era: a Swedish Lymphoma Register study.

Autor: Sonnevi K; Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.; Hematology Dept, Karolinska University Hospital, Stockholm, Sweden., Wästerlid T; Hematology Dept, Karolinska University Hospital, Stockholm, Sweden.; Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden., Melén CM; Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.; Hematology Dept, Karolinska University Hospital, Stockholm, Sweden., Harrysson S; Hematology Dept, Karolinska University Hospital, Stockholm, Sweden.; Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden., Smedby KE; Hematology Dept, Karolinska University Hospital, Stockholm, Sweden.; Unit of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden., Wahlin BE; Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.; Hematology Dept, Karolinska University Hospital, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2021 Jan; Vol. 192 (1), pp. 75-81. Date of Electronic Publication: 2020 May 12.
DOI: 10.1111/bjh.16737
Abstrakt: Diffuse large B-cell lymphoma (DLBCL) incidence rises with increasing age. Rituximab-anthracycline-based regimens offer a potential cure but also risks of adverse events, especially in the elderly. Using Swedish registers, we conducted a nationwide, population-based study of DLBCL in the very elderly. We obtained information on clinical characteristics, residence, comorbidity, therapy and survival for the 1194 patients aged ≥80 years diagnosed in Sweden 2007-2014. To address selection bias, we also investigated treatment differences between Sweden's Healthcare Regions and whether there were survival differences between the Regions. The 2-year overall and relative survivals were better in patients aged ≥80 years given treatment with curative intent (54%; 64%) than low-intensity (26%; 33%), or palliative treatment (6%; 7%). The fraction of patients treated with curative intent varied between the Healthcare Regions (45-76%). Survival was significantly inferior in Regions with few patients treated with curative intent (multivariable hazard ratio 1.3, 95% confidence interval 1.1-1.6). When treatment intensity and Regions competed, Regions were no longer independent, suggesting that Regional survival differences are due to therapeutic differences. Furthermore, we found that the age-adjusted International Prognostic Index was independently associated with survival. We conclude that patients aged ≥80 years with DLBCL appear to benefit from rituximab-anthracycline-based treatment given with curative intent.
(© 2020 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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