REDUCED RCHOP FOR ELDERLY PATIENTS WITH DLBCL
(Abstract release date: 05/19/16)
EHA Library. Vidal L. 06/09/16; 132511; E962
Dr. Liat Vidal
Contributions
Contributions
Abstract
Abstract: E962
Type: Eposter Presentation
Background
RCHOP regimen is considered the standard of care for patients with diffuse large B-cell lymphoma (DLBCL). Elderly patients often have comorbidities, worse performance status, less hematologic reserve and are more prone to changes in pharmacokinetics, which lead to higher rates of toxicity. Therefore it was suggested that elderly patients should be treated with reduced intensity RCHOP regimen. Very few studies examined regimens of reduced intensity RCHOP.
Aims
To evaluate the effect of dose reduction of RCHOP on survival, disease control and toxicity in patients 70 years or older with DLBCL.
Methods
We performed a retrospective cohort study including patients with DLBCL treated with RCHOP at the Rabin Medical Center between the years 2004-2014. We excluded patients with transformation or CNS involvement. We collected age, sex, performance status (PS), B symptoms, bone marrow involvement, number of extranodal involvement sites, Ann Arbor stage, international prognostic index (IPI), bulky disease, Charlson comorbidity index (Charlson), hemoglobin (Hb), LDH, neutrophil, lymphocyte, monocyte, and platelet count, creatinine, albumin, CRP, cardiac ejection function, RCHOP dose (for each drug separately) and treatment date, response, and survival. We defined full, standard dose (SD) as 90% and above of standard adriamycin dose, and reduced dose (RD) as less than 90% in the first cycle. OS was compared using Kaplan-Meier survival analysis. Variables potentially associated with mortality were entered into a Cox regression multivariate analysis.
Results
Results: 140 patients were eligible. Median dose reduction was by 88%. Median age was 80 years in the RD group, and 76 years in SD group (p<0.001). Patients in the RD group were older, had a worse PS, and a higher IPI and Ki67, and lower albumin, Hb, and lymphocyte count. There were no differences between the groups regarding sex, B symptoms, bone marrow involvement, number of extranodal involvement sites, stage, bulky disease, Charlson, LDH, neutrophil, monocyte, and platelet count, creatinine, and CRP. 3% of patients had cardiac ejection function <45%. Patients treated with RD RCHOP had statistically significant lower risk of achieving complete response (CR) (HR forIn a univariate model of OS RD group (HR 2.53, 95% CI 1.57-4.07, p=0.0001), older age, advanced stage, more than 1 extranodal site involvement, performance status more than 1, higher IPI, lower albumin and Hb levels had negative prognostic effect on survival. In multivariate model 1 including age, sex, Charlson, and Hb the negative effect of RD treatment remained statistically significant compared to SD (HR 1.93, 95% CI 1.18-3.15, p=0.01) as well as age and Hb. In model 2 including treatment group, age, sex, PS, IPI, LDH, and albumin there was a trend towards worse survival with RD RCHOP compared to SD (HR 1.64, 95% CI 0.96-2.82, p=0.069). Age, sex, IPI, and albumin remained prognostic in this model.There was no statistically difference in the rate of any infection between the groups (p=0.623). Patients treated with RD RCHOP were hospitalized more than patients treated with SD RCHOP (median 4 vs. 1 day, respectively).
Conclusion
Based on retrospective data, dose reduction of adriamycin in the first cycle of R-CHOP may reduce the chance to achieve CR and impair OS. This should be further evaluated in randomized trials. We will further explore the effect of dose intensity and density in all cycles of RCHOP on PFS and OS.
Session topic: E-poster
Keyword(s): Chemotherapy, CHOP, Diffuse large B cell lymphoma, Elderly
Type: Eposter Presentation
Background
RCHOP regimen is considered the standard of care for patients with diffuse large B-cell lymphoma (DLBCL). Elderly patients often have comorbidities, worse performance status, less hematologic reserve and are more prone to changes in pharmacokinetics, which lead to higher rates of toxicity. Therefore it was suggested that elderly patients should be treated with reduced intensity RCHOP regimen. Very few studies examined regimens of reduced intensity RCHOP.
Aims
To evaluate the effect of dose reduction of RCHOP on survival, disease control and toxicity in patients 70 years or older with DLBCL.
Methods
We performed a retrospective cohort study including patients with DLBCL treated with RCHOP at the Rabin Medical Center between the years 2004-2014. We excluded patients with transformation or CNS involvement. We collected age, sex, performance status (PS), B symptoms, bone marrow involvement, number of extranodal involvement sites, Ann Arbor stage, international prognostic index (IPI), bulky disease, Charlson comorbidity index (Charlson), hemoglobin (Hb), LDH, neutrophil, lymphocyte, monocyte, and platelet count, creatinine, albumin, CRP, cardiac ejection function, RCHOP dose (for each drug separately) and treatment date, response, and survival. We defined full, standard dose (SD) as 90% and above of standard adriamycin dose, and reduced dose (RD) as less than 90% in the first cycle. OS was compared using Kaplan-Meier survival analysis. Variables potentially associated with mortality were entered into a Cox regression multivariate analysis.
Results
Results: 140 patients were eligible. Median dose reduction was by 88%. Median age was 80 years in the RD group, and 76 years in SD group (p<0.001). Patients in the RD group were older, had a worse PS, and a higher IPI and Ki67, and lower albumin, Hb, and lymphocyte count. There were no differences between the groups regarding sex, B symptoms, bone marrow involvement, number of extranodal involvement sites, stage, bulky disease, Charlson, LDH, neutrophil, monocyte, and platelet count, creatinine, and CRP. 3% of patients had cardiac ejection function <45%. Patients treated with RD RCHOP had statistically significant lower risk of achieving complete response (CR) (HR forIn a univariate model of OS RD group (HR 2.53, 95% CI 1.57-4.07, p=0.0001), older age, advanced stage, more than 1 extranodal site involvement, performance status more than 1, higher IPI, lower albumin and Hb levels had negative prognostic effect on survival. In multivariate model 1 including age, sex, Charlson, and Hb the negative effect of RD treatment remained statistically significant compared to SD (HR 1.93, 95% CI 1.18-3.15, p=0.01) as well as age and Hb. In model 2 including treatment group, age, sex, PS, IPI, LDH, and albumin there was a trend towards worse survival with RD RCHOP compared to SD (HR 1.64, 95% CI 0.96-2.82, p=0.069). Age, sex, IPI, and albumin remained prognostic in this model.There was no statistically difference in the rate of any infection between the groups (p=0.623). Patients treated with RD RCHOP were hospitalized more than patients treated with SD RCHOP (median 4 vs. 1 day, respectively).
Conclusion
Based on retrospective data, dose reduction of adriamycin in the first cycle of R-CHOP may reduce the chance to achieve CR and impair OS. This should be further evaluated in randomized trials. We will further explore the effect of dose intensity and density in all cycles of RCHOP on PFS and OS.
Session topic: E-poster
Keyword(s): Chemotherapy, CHOP, Diffuse large B cell lymphoma, Elderly
Abstract: E962
Type: Eposter Presentation
Background
RCHOP regimen is considered the standard of care for patients with diffuse large B-cell lymphoma (DLBCL). Elderly patients often have comorbidities, worse performance status, less hematologic reserve and are more prone to changes in pharmacokinetics, which lead to higher rates of toxicity. Therefore it was suggested that elderly patients should be treated with reduced intensity RCHOP regimen. Very few studies examined regimens of reduced intensity RCHOP.
Aims
To evaluate the effect of dose reduction of RCHOP on survival, disease control and toxicity in patients 70 years or older with DLBCL.
Methods
We performed a retrospective cohort study including patients with DLBCL treated with RCHOP at the Rabin Medical Center between the years 2004-2014. We excluded patients with transformation or CNS involvement. We collected age, sex, performance status (PS), B symptoms, bone marrow involvement, number of extranodal involvement sites, Ann Arbor stage, international prognostic index (IPI), bulky disease, Charlson comorbidity index (Charlson), hemoglobin (Hb), LDH, neutrophil, lymphocyte, monocyte, and platelet count, creatinine, albumin, CRP, cardiac ejection function, RCHOP dose (for each drug separately) and treatment date, response, and survival. We defined full, standard dose (SD) as 90% and above of standard adriamycin dose, and reduced dose (RD) as less than 90% in the first cycle. OS was compared using Kaplan-Meier survival analysis. Variables potentially associated with mortality were entered into a Cox regression multivariate analysis.
Results
Results: 140 patients were eligible. Median dose reduction was by 88%. Median age was 80 years in the RD group, and 76 years in SD group (p<0.001). Patients in the RD group were older, had a worse PS, and a higher IPI and Ki67, and lower albumin, Hb, and lymphocyte count. There were no differences between the groups regarding sex, B symptoms, bone marrow involvement, number of extranodal involvement sites, stage, bulky disease, Charlson, LDH, neutrophil, monocyte, and platelet count, creatinine, and CRP. 3% of patients had cardiac ejection function <45%. Patients treated with RD RCHOP had statistically significant lower risk of achieving complete response (CR) (HR forIn a univariate model of OS RD group (HR 2.53, 95% CI 1.57-4.07, p=0.0001), older age, advanced stage, more than 1 extranodal site involvement, performance status more than 1, higher IPI, lower albumin and Hb levels had negative prognostic effect on survival. In multivariate model 1 including age, sex, Charlson, and Hb the negative effect of RD treatment remained statistically significant compared to SD (HR 1.93, 95% CI 1.18-3.15, p=0.01) as well as age and Hb. In model 2 including treatment group, age, sex, PS, IPI, LDH, and albumin there was a trend towards worse survival with RD RCHOP compared to SD (HR 1.64, 95% CI 0.96-2.82, p=0.069). Age, sex, IPI, and albumin remained prognostic in this model.There was no statistically difference in the rate of any infection between the groups (p=0.623). Patients treated with RD RCHOP were hospitalized more than patients treated with SD RCHOP (median 4 vs. 1 day, respectively).
Conclusion
Based on retrospective data, dose reduction of adriamycin in the first cycle of R-CHOP may reduce the chance to achieve CR and impair OS. This should be further evaluated in randomized trials. We will further explore the effect of dose intensity and density in all cycles of RCHOP on PFS and OS.
Session topic: E-poster
Keyword(s): Chemotherapy, CHOP, Diffuse large B cell lymphoma, Elderly
Type: Eposter Presentation
Background
RCHOP regimen is considered the standard of care for patients with diffuse large B-cell lymphoma (DLBCL). Elderly patients often have comorbidities, worse performance status, less hematologic reserve and are more prone to changes in pharmacokinetics, which lead to higher rates of toxicity. Therefore it was suggested that elderly patients should be treated with reduced intensity RCHOP regimen. Very few studies examined regimens of reduced intensity RCHOP.
Aims
To evaluate the effect of dose reduction of RCHOP on survival, disease control and toxicity in patients 70 years or older with DLBCL.
Methods
We performed a retrospective cohort study including patients with DLBCL treated with RCHOP at the Rabin Medical Center between the years 2004-2014. We excluded patients with transformation or CNS involvement. We collected age, sex, performance status (PS), B symptoms, bone marrow involvement, number of extranodal involvement sites, Ann Arbor stage, international prognostic index (IPI), bulky disease, Charlson comorbidity index (Charlson), hemoglobin (Hb), LDH, neutrophil, lymphocyte, monocyte, and platelet count, creatinine, albumin, CRP, cardiac ejection function, RCHOP dose (for each drug separately) and treatment date, response, and survival. We defined full, standard dose (SD) as 90% and above of standard adriamycin dose, and reduced dose (RD) as less than 90% in the first cycle. OS was compared using Kaplan-Meier survival analysis. Variables potentially associated with mortality were entered into a Cox regression multivariate analysis.
Results
Results: 140 patients were eligible. Median dose reduction was by 88%. Median age was 80 years in the RD group, and 76 years in SD group (p<0.001). Patients in the RD group were older, had a worse PS, and a higher IPI and Ki67, and lower albumin, Hb, and lymphocyte count. There were no differences between the groups regarding sex, B symptoms, bone marrow involvement, number of extranodal involvement sites, stage, bulky disease, Charlson, LDH, neutrophil, monocyte, and platelet count, creatinine, and CRP. 3% of patients had cardiac ejection function <45%. Patients treated with RD RCHOP had statistically significant lower risk of achieving complete response (CR) (HR forIn a univariate model of OS RD group (HR 2.53, 95% CI 1.57-4.07, p=0.0001), older age, advanced stage, more than 1 extranodal site involvement, performance status more than 1, higher IPI, lower albumin and Hb levels had negative prognostic effect on survival. In multivariate model 1 including age, sex, Charlson, and Hb the negative effect of RD treatment remained statistically significant compared to SD (HR 1.93, 95% CI 1.18-3.15, p=0.01) as well as age and Hb. In model 2 including treatment group, age, sex, PS, IPI, LDH, and albumin there was a trend towards worse survival with RD RCHOP compared to SD (HR 1.64, 95% CI 0.96-2.82, p=0.069). Age, sex, IPI, and albumin remained prognostic in this model.There was no statistically difference in the rate of any infection between the groups (p=0.623). Patients treated with RD RCHOP were hospitalized more than patients treated with SD RCHOP (median 4 vs. 1 day, respectively).
Conclusion
Based on retrospective data, dose reduction of adriamycin in the first cycle of R-CHOP may reduce the chance to achieve CR and impair OS. This should be further evaluated in randomized trials. We will further explore the effect of dose intensity and density in all cycles of RCHOP on PFS and OS.
Session topic: E-poster
Keyword(s): Chemotherapy, CHOP, Diffuse large B cell lymphoma, Elderly
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