R-CVP regimen is active in frail elderly patients aged 80 or over with diffuse large B cell lymphoma

Autor: Anne Besançon, Andreaa Anghel, Habib Ghnaya, Delphine Bolle, Jeremy Sandrini, Alix Baugier de Materre, Jonathan Farhi, Catherine Truong, Nathalie Denizon, Kamel Laribi
Přispěvatelé: Centre hospitalier du Mans, Centre Hospitalier Le Mans (CH Le Mans), Pôle Santé Sud
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Frail Elderly
Salvage therapy
Kaplan-Meier Estimate
Infections
Severity of Illness Index
Disease-Free Survival
03 medical and health sciences
0302 clinical medicine
International Prognostic Index
Prednisone
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Survival rate
Cyclophosphamide
R-CVP Regimen
Proportional Hazards Models
Retrospective Studies
Aged
80 and over
Salvage Therapy
Performance status
business.industry
[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology
[SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology
Hematology
General Medicine
medicine.disease
Hematologic Diseases
3. Good health
Surgery
Regimen
Treatment Outcome
Cardiovascular Diseases
Doxorubicin
Vincristine
030220 oncology & carcinogenesis
Female
Kidney Diseases
Lymphoma
Large B-Cell
Diffuse
business
Rituximab
Diffuse large B-cell lymphoma
030215 immunology
medicine.drug
Zdroj: Annals of Hematology
Annals of Hematology, Springer Verlag, 2016, ⟨10.1007/s00277-016-2768-x⟩
ISSN: 1432-0584
0939-5555
DOI: 10.1007/s00277-016-2768-x⟩
Popis: International audience; Patients aged 80 or over with diffuse large B cell lymphoma (DLBCL) often have comorbidities that increase drug toxicity and prevent the use of otherwise optimal treatment. We performed a retrospective analysis of 43 patients aged 80 or over (median age: 83; range: 80–93) unable to receive treatment with anthracyclines, at diagnosis of DLBCL, treated with an R-CVP treatment (standard R-CHOP without doxorubicin). The patients had one or more comorbidities: 18 patients (41.9 %) had a performance status (PS) of 3; 23 patients (53.5 %) had low creatinine clearance; 12 patients (27.9 %) had low left ventricular ejection fraction; seven patients (16.3 %) had poor hepatic function; and 26 patients (60.5 %) had a Charlson index score ≥4. Thirty patients (70 %) had two or three adverse factors according to the age-adjusted International Prognostic Index. Twenty-five patients (58.1 %) received eight cycles of R-CVP, but the full eight cycles could not be given to 18 patients (41.9 %). The OR rate was 58.1 % (CR 37.2 %). There were 34 deaths (79 %) during treatment and follow-up. Ten patients (23.3 %) died early from toxicity before interim evaluation; all had PS 3. The median follow-up of surviving patients was 52.6 months. The overall 2-year survival rate was 31.9 % and the median OS was 12.6 months. The median OS for patients who completed the entire treatment was 26.4 months. The median PFS was 11.2 months. In multivariate analyses, OS was only affected by performance status ≥2 and Charlson index score ≥4. The R-CVP regimen can be active in elderly frail patients aged 80 or more with DLBCL, but systematic geriatric assessment is required so that those unsuitable for chemotherapy are excluded.
Databáze: OpenAIRE
Externí odkaz: