Contributions
Abstract: EP513
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Diffuse Large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in the elderly.some elderly patients can not tolerate the standard dose of R-CHOP due to age, poor physical condition, and severe complications. At present, the decision to treat a patient is made by clinical experience of clinicians, which is subjective . It is a major challenge to identify which patients can tolerate the standard dose of R-CHOP regimen in our clinical work. Comprehensive Geriatric Assessment (CGA) has been proposed as an objective tool for supporting treatment decision by age, evaluating activity of daily living, Instrumental activities of daily Living, and comorbidity score according to the Cumulative Illness Rating Score for Geriatrics (CIRS-G).However, It is still unknown whether comprehensive geriatric assessment or clinical judgment was more effective at guide the treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL) .
Aims
This prospective, observational, controlled cohort trial aims to investigate whether comprehensive geriatric assessment (CGA) is more effective than clinical judgment to guide the treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL) in China.
Methods
152 patients in Beijing Hospital were enrolled if they fulfilled the following inclusion criteria: 1)age ≥60 years; 2) newly diagnosed of DLBCL according to WHO classification by two independent pathologists; 3) no previous history of hematologic malignancies; 76 patients will received CGA-driven therapy at CGA-guided therapy group, and 76 patients will received therapy based on clinical judgement at clinical judgement-guided therapy group. the 2-year Overall Survival (OS), Progression Free Survival (PFS), Overall Response Rate (ORR) and toxicities were analyzed between the two group.
Results
according to CGA, 76 patients in the CGA-guided therapy group were classified into three groups: fit (41 patients, 53.9%), unfit(4 patients, 5.3%) and frail group (31 patients, 40.8%). patients assessed as unfit or frail group received a reduced dose of anthracycline of R-CHOP or R-miniCHOP or R-COP. the ORR was 94.7% (72/76), including CR rate was 73.7% (56/76). 2-year OS rates was 80.9%, 2-year PFS rates was 72.7%. however, in the clinical judgement-guided therapy group, based on the CGA assessment, 41(53.9%) patients were assessed as fit group,including 36 patients received a standard dose of R-CHOP regimen.4(5.3%) as unfit group, 31(40.8%) as frail group including 4 patients in the frail group received a standard dose of R-CHOP regimen.the ORR was 81.6% (62/76), including CR rate was 57.9% (44/76). 2-year OS rates was 63.0%, 2-year PFS was 52.7%. there were significant difference between the two groups(ORR: x2=5.104, p=0.024; CR:x2=4.209, p=0.04; 2-year OS rates: x2=7.348, p = 0.007; 2-year PFS: x2=10.768, p = 0.001).Subgroup analysis showed that the complete remission rate in the fit group of patients in the CGA-guided therapy group was 82.9%(34/41), which was significantly higher than that in the clinical judgement-guided therapy group(58.5%, 24/41)(P = 0.015). The 2- year OS rate and 2-year PFS rate of patients in the CGA-guided therapy group were 86.9% and 76.5%, respectively, which were significantly higher than those in the clinical judgement-guided therapy group(62.1%, P = 0.000) and 62.9% (P = 0.000), respectively. the toxicity between two group was similar.
Conclusion
Using CGA to guide therapy for elderly patients with DLBCL can significantly improves the clinical efficacy and survival rate.
Keyword(s): DLBCL, Elderly, Treatment
Abstract: EP513
Type: E-Poster Presentation
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Diffuse Large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in the elderly.some elderly patients can not tolerate the standard dose of R-CHOP due to age, poor physical condition, and severe complications. At present, the decision to treat a patient is made by clinical experience of clinicians, which is subjective . It is a major challenge to identify which patients can tolerate the standard dose of R-CHOP regimen in our clinical work. Comprehensive Geriatric Assessment (CGA) has been proposed as an objective tool for supporting treatment decision by age, evaluating activity of daily living, Instrumental activities of daily Living, and comorbidity score according to the Cumulative Illness Rating Score for Geriatrics (CIRS-G).However, It is still unknown whether comprehensive geriatric assessment or clinical judgment was more effective at guide the treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL) .
Aims
This prospective, observational, controlled cohort trial aims to investigate whether comprehensive geriatric assessment (CGA) is more effective than clinical judgment to guide the treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL) in China.
Methods
152 patients in Beijing Hospital were enrolled if they fulfilled the following inclusion criteria: 1)age ≥60 years; 2) newly diagnosed of DLBCL according to WHO classification by two independent pathologists; 3) no previous history of hematologic malignancies; 76 patients will received CGA-driven therapy at CGA-guided therapy group, and 76 patients will received therapy based on clinical judgement at clinical judgement-guided therapy group. the 2-year Overall Survival (OS), Progression Free Survival (PFS), Overall Response Rate (ORR) and toxicities were analyzed between the two group.
Results
according to CGA, 76 patients in the CGA-guided therapy group were classified into three groups: fit (41 patients, 53.9%), unfit(4 patients, 5.3%) and frail group (31 patients, 40.8%). patients assessed as unfit or frail group received a reduced dose of anthracycline of R-CHOP or R-miniCHOP or R-COP. the ORR was 94.7% (72/76), including CR rate was 73.7% (56/76). 2-year OS rates was 80.9%, 2-year PFS rates was 72.7%. however, in the clinical judgement-guided therapy group, based on the CGA assessment, 41(53.9%) patients were assessed as fit group,including 36 patients received a standard dose of R-CHOP regimen.4(5.3%) as unfit group, 31(40.8%) as frail group including 4 patients in the frail group received a standard dose of R-CHOP regimen.the ORR was 81.6% (62/76), including CR rate was 57.9% (44/76). 2-year OS rates was 63.0%, 2-year PFS was 52.7%. there were significant difference between the two groups(ORR: x2=5.104, p=0.024; CR:x2=4.209, p=0.04; 2-year OS rates: x2=7.348, p = 0.007; 2-year PFS: x2=10.768, p = 0.001).Subgroup analysis showed that the complete remission rate in the fit group of patients in the CGA-guided therapy group was 82.9%(34/41), which was significantly higher than that in the clinical judgement-guided therapy group(58.5%, 24/41)(P = 0.015). The 2- year OS rate and 2-year PFS rate of patients in the CGA-guided therapy group were 86.9% and 76.5%, respectively, which were significantly higher than those in the clinical judgement-guided therapy group(62.1%, P = 0.000) and 62.9% (P = 0.000), respectively. the toxicity between two group was similar.
Conclusion
Using CGA to guide therapy for elderly patients with DLBCL can significantly improves the clinical efficacy and survival rate.
Keyword(s): DLBCL, Elderly, Treatment