OUTCOME OF ELDERLY DLBCL PATIENTS (≥ 80 YEARS) TREATED WITH ANTHRACYCLINE BASED CHEMOTHERAPY; R-CHOP DOSE REDUCTION IS NOT NECESSARY FOR EVERYBODY
Author(s): ,
Marek Trněný
Affiliations:
Charles University General Hospital,Prague,Czech Republic
,
Andrea Janikova
Affiliations:
University Hospital,Brno,Czech Republic
,
Alice Sykorova
Affiliations:
University Hospital,Hradec Kralove,Czech Republic
,
Vit Prochazka
Affiliations:
University Hospital,Olomouc,Czech Republic
,
Heidi Mocikova
Affiliations:
University Hospital Kralovske Vinohrady,Prague,Czech Republic
,
Pavel Klener
Affiliations:
Charles University General Hospital,Prague,Czech Republic
,
David Salek
Affiliations:
University Hospital,Brno,Czech Republic
,
David Belada
Affiliations:
University Hospital,Hradec Kralove,Czech Republic
,
Katerina Benesova
Affiliations:
Charles University General Hospital,Prague,Czech Republic
,
Robert Pytlik
Affiliations:
Charles University General Hospital,Prague,Czech Republic
,
Petra Blahovcova
Affiliations:
CLSG Data Center,Prague,Czech Republic
,
Ludmila Boudova
Affiliations:
University Hospital,Pilsen,Czech Republic
Vit Campr
Affiliations:
University Hospital Motol,Prague,Czech Republic
(Abstract release date: 05/18/17) EHA Library. Trneny M. 06/23/17; 181505; P218
Prof. Dr. Marek Trneny
Prof. Dr. Marek Trneny
Contributions
Abstract

Abstract: P218

Type: Poster Presentation

Presentation during EHA22: On Friday, June 23, 2017 from 17:15 - 18:45

Location: Poster area (Hall 7)

Background
Management of elderly patients (above ≥ 80y) is difficult and only limited number of patients could be treated by curative approach with anthracycline based chemotherapy.  Dose reduction of particular drugs is used very often and it varies based on pt’s characteristics and center preferences. There is however lack of randomized or at least non-randomized historical comparisons. 

Aims
The objective of this study is to analyze elderly DLBCL patients prospectively registered in NiHiL Lymphoma Project  and treated anthracycline based regimen in real world outside of clinical trials. 

Methods
Patients (pts.) with informed consent are prospectively followed in multicenter Lymphoma Project  since 1999. Diagnostic, therapeutic and follow up data are prospectively collected.  There were 399 DLBCL pts  older than 80year diagnosed in period 1999-2014 identified. Among 372 pts. with pathology review and essential data there were 112 pts. (30.1%) treated with R-CHOPlike chemotherapy. Analysis of clinical prognostic factors, therapy and toxicity was performed. Pearson, Kaplan-Maier and log rank tests were used. 

Results
Median age was 81 years (80-88), 51.8% of men.  Proportion of pts ³85 was 14.3 %, with PS ≥ 2 (ECOG) 34.0%, with  higher LDH 64.3%, with high or intermediate high IPI 49.1%,  with bulky disease (≥10 cm) 17.0%, with lower albumin 27.7%, with Charlson Comorbidity Score (CCS) ≥ 4 25%. According to treatment choice of physician (intent to treat), pts. could be divided into 3 groups R-CHOP (CH) (cyclophosphamide –CF 750 mg/m2, adriamycin – A - 50 mg/m2) or R-MiniCHOP (miniCH)  (CF 400 mg/ m2, A 25 mg/ m2, Peyrade 2011) or  modified R-CHOP (modiCH) (CF 750 mg/m2and A 25 mg/m2 or any other dose  between CHOP and miniCHOP). There were 21 pts (18.8%) treated with CH, 38 (33.9%) with miniCH  and 53 (47.3%) with modiCH. There were no signficant differences between the subgroups, except higher proportion of bulk in modiCH vs miniCH and CH (35% vs 12.9% vs 7.7% resp.; p 0.04) and cardiac comorbidity (60.5% vs 33.3% vs 30.2% resp.; p 0.02). Six and more cycles were administered in 71.4%, 63.1% and 58.5% pts. in CH, miniCH and modiCH resp. Following proportion of pts. received >80% (>50%) of original CHOP dose.  For cyclophosphamide it was 66.7% (81%), 0% (50%) and 62.2% (79.2%) resp. and for A it was 57.1% (76.1%), 2.6% (15.8%) and 13.2% (49%) resp. for CH, miniCH and modiCH resp..  There were observed 11 treatment related deaths (6 cardiac toxicity and 4 infection), 5 in miniCH and 6 in modiCH groups. The overall response rate was 76.8% with 59.8% CR/CRu.

Median PFS and OS were 2.8y and 3.5y resp. (figure A) with median follow up of  3.3y. There were found high beta2microglobulin (HR 2.2, p 0.05), low albumin (HR 1.9, p 0.05)  and PS (p 0.05) as the only factors correlated with OS as well as PFS (data not shown). Pts who achieved CR or PR have significantly better OS median (as well as PFS) compared to stable or progressive disease with 4.6 vs 3.5 vs 0.8 vs 0.5 y. There was numerically (not significantly) better OS median for R-CHOP (4.6y) vs R-miniCHOP (3.2y) and R-modiCHOP (2.9y) (Figure B).

Conclusion
Only one third of elderly DLBCL pts (≥80y) is treated with anthracycline based regimen. Performance status, albumin and beta2microblobulin levels were significantly associated with prognosis. In minority of these pts full dose of R-CHOP could be safely used and there is trend to better overall survival.

Supported by AZV 16-31092A

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): Lymphoma therapy, Elderly, DLBCL, CHOP

Abstract: P218

Type: Poster Presentation

Presentation during EHA22: On Friday, June 23, 2017 from 17:15 - 18:45

Location: Poster area (Hall 7)

Background
Management of elderly patients (above ≥ 80y) is difficult and only limited number of patients could be treated by curative approach with anthracycline based chemotherapy.  Dose reduction of particular drugs is used very often and it varies based on pt’s characteristics and center preferences. There is however lack of randomized or at least non-randomized historical comparisons. 

Aims
The objective of this study is to analyze elderly DLBCL patients prospectively registered in NiHiL Lymphoma Project  and treated anthracycline based regimen in real world outside of clinical trials. 

Methods
Patients (pts.) with informed consent are prospectively followed in multicenter Lymphoma Project  since 1999. Diagnostic, therapeutic and follow up data are prospectively collected.  There were 399 DLBCL pts  older than 80year diagnosed in period 1999-2014 identified. Among 372 pts. with pathology review and essential data there were 112 pts. (30.1%) treated with R-CHOPlike chemotherapy. Analysis of clinical prognostic factors, therapy and toxicity was performed. Pearson, Kaplan-Maier and log rank tests were used. 

Results
Median age was 81 years (80-88), 51.8% of men.  Proportion of pts ³85 was 14.3 %, with PS ≥ 2 (ECOG) 34.0%, with  higher LDH 64.3%, with high or intermediate high IPI 49.1%,  with bulky disease (≥10 cm) 17.0%, with lower albumin 27.7%, with Charlson Comorbidity Score (CCS) ≥ 4 25%. According to treatment choice of physician (intent to treat), pts. could be divided into 3 groups R-CHOP (CH) (cyclophosphamide –CF 750 mg/m2, adriamycin – A - 50 mg/m2) or R-MiniCHOP (miniCH)  (CF 400 mg/ m2, A 25 mg/ m2, Peyrade 2011) or  modified R-CHOP (modiCH) (CF 750 mg/m2and A 25 mg/m2 or any other dose  between CHOP and miniCHOP). There were 21 pts (18.8%) treated with CH, 38 (33.9%) with miniCH  and 53 (47.3%) with modiCH. There were no signficant differences between the subgroups, except higher proportion of bulk in modiCH vs miniCH and CH (35% vs 12.9% vs 7.7% resp.; p 0.04) and cardiac comorbidity (60.5% vs 33.3% vs 30.2% resp.; p 0.02). Six and more cycles were administered in 71.4%, 63.1% and 58.5% pts. in CH, miniCH and modiCH resp. Following proportion of pts. received >80% (>50%) of original CHOP dose.  For cyclophosphamide it was 66.7% (81%), 0% (50%) and 62.2% (79.2%) resp. and for A it was 57.1% (76.1%), 2.6% (15.8%) and 13.2% (49%) resp. for CH, miniCH and modiCH resp..  There were observed 11 treatment related deaths (6 cardiac toxicity and 4 infection), 5 in miniCH and 6 in modiCH groups. The overall response rate was 76.8% with 59.8% CR/CRu.

Median PFS and OS were 2.8y and 3.5y resp. (figure A) with median follow up of  3.3y. There were found high beta2microglobulin (HR 2.2, p 0.05), low albumin (HR 1.9, p 0.05)  and PS (p 0.05) as the only factors correlated with OS as well as PFS (data not shown). Pts who achieved CR or PR have significantly better OS median (as well as PFS) compared to stable or progressive disease with 4.6 vs 3.5 vs 0.8 vs 0.5 y. There was numerically (not significantly) better OS median for R-CHOP (4.6y) vs R-miniCHOP (3.2y) and R-modiCHOP (2.9y) (Figure B).

Conclusion
Only one third of elderly DLBCL pts (≥80y) is treated with anthracycline based regimen. Performance status, albumin and beta2microblobulin levels were significantly associated with prognosis. In minority of these pts full dose of R-CHOP could be safely used and there is trend to better overall survival.

Supported by AZV 16-31092A

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): Lymphoma therapy, Elderly, DLBCL, CHOP

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