OLDER PATIENTS WITH DLCLB-SHOULD ALL BE TREATED WITH INTENT TO CURE?
(Abstract release date: 05/19/16)
EHA Library. Purić M. 06/09/16; 134596; PB1696
Dr. Mila Purić
Contributions
Contributions
Abstract
Abstract: PB1696
Type: Publication Only
Background
The incidence of diffuse large B cell lymphoma (DLCLB) increases in the elderly. Older age is associated with the presence of concomitant disease making the therapy difficult. Concidering the results of earlier studies, age itself should not be a justification for a paliative care decisions or reduced intensity chemotherapy. However, elderly patrients as more fragile, do not always receive the right treatment. So, the best method for identifying non-fit patients is not known.
Aims
To evaluate if Age Adjusted Carlson score (AACS) at diagnosis can predict clinical outcome in older patients with DLCLB receiving the first– line chemotherapy.
Methods
Patients at the Institution for Oncology and radiology of Serbia between 2005 and 2015 who were diagnosed and received first-line chemotherapy for DLCLB, older than 65 years were enrolled. Clinical and treatment data were recorded including AACS at the diagnosis. Survival time was estimated using the Kaplan- Meier (KM) method, and Cox proportional hazard model was used to evaluate the risk factors significance for survival. A p-value <0.05 was considered significant.
Results
87 patients were included in the study. 23 (26.44%) patients were older than 75 years, 52 (59.77%) were female, 38 (43.67%) were Ann Arbor stage 1 and 2, 28 (32.18%) were International prognostic index (IPI) score 0-1; and 38 (43.68%) were intermediate high or high risk. 44 (50.57%) patients were AACS≤5 and 43 (49.43%) patients were AACS≥6. Extronadal involvement was present in 65 (74.71%) patients at diagnosis. 60 (68.97%) patients were treated with Rituximab. 38 (43.68%) patients received CHOP, 27 (31.03%) mCHOP, 12 (13.79%) CVP and 10 (11.49%) CEOP regimen, with or without Rituximab. Statistically significant difference for overal responce rate (ORR) was registered between CHOP and CVP arm (p=0.004), as for mCHOP and CVP arm (p= 0.001). CEOP was not inferior to CHOP (p=0.37) and mCHOP(p=0.47) in term of ORR. Complete responce rate (CRR) was significantly better in CHOP (73.68%), m CHOP (74.07%) and CEOP (80%) groups, than in CVP group (25%). ORR and CRR were better when Rituximab was used (ORR and CRR were 100% and 79.31%/78.26% for RCHOP/RmCHOP, but 88.89%/50% and 55.56%/50% for CHOP/mCHOP). There was no difference in toxicity among chemotherapy regimens. After a median follow-up of 43 months (range, 1-128), median overal survival (OS) times were 91 months (54-not reached) for CHOP, 8.5 months (2- not reached) for CVP. Median OS was not reached for mCHOP and CEOP arm. The CVP regimen was associated with a significantly worse OS and PFS than was the CHOP regimen (p=0.0002) or mCHOP regimen (p=0.0006). CHOP was uncommon in AACS≥6 group (p=0.003). There was no difference between AACS≤5 and AACS ≥6 groups in the frequency of other chemotherapy regimens. ORR was significantly better in AACS≤5 (p=0.005). Median OS were not reached for AACS≤5 and 43 months (20- not reached) for AACS≥6. Patients with AACS≥6 had significantly shorter PFS (p=0.006) and OS (p=0.001) than patients with AACS≤5.
Conclusion
AACS≤5 was associated with a significant reduction in the risk of death among older patients with DLCLB treated with different chemotherapy regimens. This study suggests that AACS may predict responce to chemotherapy and survival in older patients with newly diagnosed DLCLB. As predictive biomarker and clinical prognostic indicator for OS and PFS, AACS may be useful in defining the group of older DLCLB patients that would have more benefit from best supportive care instead of chemotherapy.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Elderly, Therapy
Type: Publication Only
Background
The incidence of diffuse large B cell lymphoma (DLCLB) increases in the elderly. Older age is associated with the presence of concomitant disease making the therapy difficult. Concidering the results of earlier studies, age itself should not be a justification for a paliative care decisions or reduced intensity chemotherapy. However, elderly patrients as more fragile, do not always receive the right treatment. So, the best method for identifying non-fit patients is not known.
Aims
To evaluate if Age Adjusted Carlson score (AACS) at diagnosis can predict clinical outcome in older patients with DLCLB receiving the first– line chemotherapy.
Methods
Patients at the Institution for Oncology and radiology of Serbia between 2005 and 2015 who were diagnosed and received first-line chemotherapy for DLCLB, older than 65 years were enrolled. Clinical and treatment data were recorded including AACS at the diagnosis. Survival time was estimated using the Kaplan- Meier (KM) method, and Cox proportional hazard model was used to evaluate the risk factors significance for survival. A p-value <0.05 was considered significant.
Results
87 patients were included in the study. 23 (26.44%) patients were older than 75 years, 52 (59.77%) were female, 38 (43.67%) were Ann Arbor stage 1 and 2, 28 (32.18%) were International prognostic index (IPI) score 0-1; and 38 (43.68%) were intermediate high or high risk. 44 (50.57%) patients were AACS≤5 and 43 (49.43%) patients were AACS≥6. Extronadal involvement was present in 65 (74.71%) patients at diagnosis. 60 (68.97%) patients were treated with Rituximab. 38 (43.68%) patients received CHOP, 27 (31.03%) mCHOP, 12 (13.79%) CVP and 10 (11.49%) CEOP regimen, with or without Rituximab. Statistically significant difference for overal responce rate (ORR) was registered between CHOP and CVP arm (p=0.004), as for mCHOP and CVP arm (p= 0.001). CEOP was not inferior to CHOP (p=0.37) and mCHOP(p=0.47) in term of ORR. Complete responce rate (CRR) was significantly better in CHOP (73.68%), m CHOP (74.07%) and CEOP (80%) groups, than in CVP group (25%). ORR and CRR were better when Rituximab was used (ORR and CRR were 100% and 79.31%/78.26% for RCHOP/RmCHOP, but 88.89%/50% and 55.56%/50% for CHOP/mCHOP). There was no difference in toxicity among chemotherapy regimens. After a median follow-up of 43 months (range, 1-128), median overal survival (OS) times were 91 months (54-not reached) for CHOP, 8.5 months (2- not reached) for CVP. Median OS was not reached for mCHOP and CEOP arm. The CVP regimen was associated with a significantly worse OS and PFS than was the CHOP regimen (p=0.0002) or mCHOP regimen (p=0.0006). CHOP was uncommon in AACS≥6 group (p=0.003). There was no difference between AACS≤5 and AACS ≥6 groups in the frequency of other chemotherapy regimens. ORR was significantly better in AACS≤5 (p=0.005). Median OS were not reached for AACS≤5 and 43 months (20- not reached) for AACS≥6. Patients with AACS≥6 had significantly shorter PFS (p=0.006) and OS (p=0.001) than patients with AACS≤5.
Conclusion
AACS≤5 was associated with a significant reduction in the risk of death among older patients with DLCLB treated with different chemotherapy regimens. This study suggests that AACS may predict responce to chemotherapy and survival in older patients with newly diagnosed DLCLB. As predictive biomarker and clinical prognostic indicator for OS and PFS, AACS may be useful in defining the group of older DLCLB patients that would have more benefit from best supportive care instead of chemotherapy.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Elderly, Therapy
Abstract: PB1696
Type: Publication Only
Background
The incidence of diffuse large B cell lymphoma (DLCLB) increases in the elderly. Older age is associated with the presence of concomitant disease making the therapy difficult. Concidering the results of earlier studies, age itself should not be a justification for a paliative care decisions or reduced intensity chemotherapy. However, elderly patrients as more fragile, do not always receive the right treatment. So, the best method for identifying non-fit patients is not known.
Aims
To evaluate if Age Adjusted Carlson score (AACS) at diagnosis can predict clinical outcome in older patients with DLCLB receiving the first– line chemotherapy.
Methods
Patients at the Institution for Oncology and radiology of Serbia between 2005 and 2015 who were diagnosed and received first-line chemotherapy for DLCLB, older than 65 years were enrolled. Clinical and treatment data were recorded including AACS at the diagnosis. Survival time was estimated using the Kaplan- Meier (KM) method, and Cox proportional hazard model was used to evaluate the risk factors significance for survival. A p-value <0.05 was considered significant.
Results
87 patients were included in the study. 23 (26.44%) patients were older than 75 years, 52 (59.77%) were female, 38 (43.67%) were Ann Arbor stage 1 and 2, 28 (32.18%) were International prognostic index (IPI) score 0-1; and 38 (43.68%) were intermediate high or high risk. 44 (50.57%) patients were AACS≤5 and 43 (49.43%) patients were AACS≥6. Extronadal involvement was present in 65 (74.71%) patients at diagnosis. 60 (68.97%) patients were treated with Rituximab. 38 (43.68%) patients received CHOP, 27 (31.03%) mCHOP, 12 (13.79%) CVP and 10 (11.49%) CEOP regimen, with or without Rituximab. Statistically significant difference for overal responce rate (ORR) was registered between CHOP and CVP arm (p=0.004), as for mCHOP and CVP arm (p= 0.001). CEOP was not inferior to CHOP (p=0.37) and mCHOP(p=0.47) in term of ORR. Complete responce rate (CRR) was significantly better in CHOP (73.68%), m CHOP (74.07%) and CEOP (80%) groups, than in CVP group (25%). ORR and CRR were better when Rituximab was used (ORR and CRR were 100% and 79.31%/78.26% for RCHOP/RmCHOP, but 88.89%/50% and 55.56%/50% for CHOP/mCHOP). There was no difference in toxicity among chemotherapy regimens. After a median follow-up of 43 months (range, 1-128), median overal survival (OS) times were 91 months (54-not reached) for CHOP, 8.5 months (2- not reached) for CVP. Median OS was not reached for mCHOP and CEOP arm. The CVP regimen was associated with a significantly worse OS and PFS than was the CHOP regimen (p=0.0002) or mCHOP regimen (p=0.0006). CHOP was uncommon in AACS≥6 group (p=0.003). There was no difference between AACS≤5 and AACS ≥6 groups in the frequency of other chemotherapy regimens. ORR was significantly better in AACS≤5 (p=0.005). Median OS were not reached for AACS≤5 and 43 months (20- not reached) for AACS≥6. Patients with AACS≥6 had significantly shorter PFS (p=0.006) and OS (p=0.001) than patients with AACS≤5.
Conclusion
AACS≤5 was associated with a significant reduction in the risk of death among older patients with DLCLB treated with different chemotherapy regimens. This study suggests that AACS may predict responce to chemotherapy and survival in older patients with newly diagnosed DLCLB. As predictive biomarker and clinical prognostic indicator for OS and PFS, AACS may be useful in defining the group of older DLCLB patients that would have more benefit from best supportive care instead of chemotherapy.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Elderly, Therapy
Type: Publication Only
Background
The incidence of diffuse large B cell lymphoma (DLCLB) increases in the elderly. Older age is associated with the presence of concomitant disease making the therapy difficult. Concidering the results of earlier studies, age itself should not be a justification for a paliative care decisions or reduced intensity chemotherapy. However, elderly patrients as more fragile, do not always receive the right treatment. So, the best method for identifying non-fit patients is not known.
Aims
To evaluate if Age Adjusted Carlson score (AACS) at diagnosis can predict clinical outcome in older patients with DLCLB receiving the first– line chemotherapy.
Methods
Patients at the Institution for Oncology and radiology of Serbia between 2005 and 2015 who were diagnosed and received first-line chemotherapy for DLCLB, older than 65 years were enrolled. Clinical and treatment data were recorded including AACS at the diagnosis. Survival time was estimated using the Kaplan- Meier (KM) method, and Cox proportional hazard model was used to evaluate the risk factors significance for survival. A p-value <0.05 was considered significant.
Results
87 patients were included in the study. 23 (26.44%) patients were older than 75 years, 52 (59.77%) were female, 38 (43.67%) were Ann Arbor stage 1 and 2, 28 (32.18%) were International prognostic index (IPI) score 0-1; and 38 (43.68%) were intermediate high or high risk. 44 (50.57%) patients were AACS≤5 and 43 (49.43%) patients were AACS≥6. Extronadal involvement was present in 65 (74.71%) patients at diagnosis. 60 (68.97%) patients were treated with Rituximab. 38 (43.68%) patients received CHOP, 27 (31.03%) mCHOP, 12 (13.79%) CVP and 10 (11.49%) CEOP regimen, with or without Rituximab. Statistically significant difference for overal responce rate (ORR) was registered between CHOP and CVP arm (p=0.004), as for mCHOP and CVP arm (p= 0.001). CEOP was not inferior to CHOP (p=0.37) and mCHOP(p=0.47) in term of ORR. Complete responce rate (CRR) was significantly better in CHOP (73.68%), m CHOP (74.07%) and CEOP (80%) groups, than in CVP group (25%). ORR and CRR were better when Rituximab was used (ORR and CRR were 100% and 79.31%/78.26% for RCHOP/RmCHOP, but 88.89%/50% and 55.56%/50% for CHOP/mCHOP). There was no difference in toxicity among chemotherapy regimens. After a median follow-up of 43 months (range, 1-128), median overal survival (OS) times were 91 months (54-not reached) for CHOP, 8.5 months (2- not reached) for CVP. Median OS was not reached for mCHOP and CEOP arm. The CVP regimen was associated with a significantly worse OS and PFS than was the CHOP regimen (p=0.0002) or mCHOP regimen (p=0.0006). CHOP was uncommon in AACS≥6 group (p=0.003). There was no difference between AACS≤5 and AACS ≥6 groups in the frequency of other chemotherapy regimens. ORR was significantly better in AACS≤5 (p=0.005). Median OS were not reached for AACS≤5 and 43 months (20- not reached) for AACS≥6. Patients with AACS≥6 had significantly shorter PFS (p=0.006) and OS (p=0.001) than patients with AACS≤5.
Conclusion
AACS≤5 was associated with a significant reduction in the risk of death among older patients with DLCLB treated with different chemotherapy regimens. This study suggests that AACS may predict responce to chemotherapy and survival in older patients with newly diagnosed DLCLB. As predictive biomarker and clinical prognostic indicator for OS and PFS, AACS may be useful in defining the group of older DLCLB patients that would have more benefit from best supportive care instead of chemotherapy.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Elderly, Therapy
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