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Clinical Trial
. 2012;17(6):838-46.
doi: 10.1634/theoncologist.2011-0417. Epub 2012 May 18.

Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma

Michele Spina  1 , Monica Balzarotti, Lilj Uziel, Andrés José Marìa Ferreri, Lucia Fratino, Massimo Magagnoli, Renato Talamini, Annalisa Giacalone, Elena Ravaioli, Emanuela Chimienti, Massimiliano Berretta, Arben Lleshi, Armando Santoro, Umberto Tirelli
Affiliations
Clinical Trial

Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma

Michele Spina et al. Oncologist. 2012.

Abstract

Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or de-escalate therapy, thereby reducing toxicity, with consequent risks for under- or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B-cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores. Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow-up of 64 months, 51 patients were alive, with 5-year disease-free, overall, and cause-specific survival rates of 80%, 60%, and 74%, respectively. Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA-driven treatment may result in better cure rates, especially in fit and unfit patients.

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Conflict of interest statement

Disclosures: The authors indicated no financial relationships.

Section Editors: Hyman B. Muss: Pfizer, Amgen, Roche, BMS, Boehringer-Ingelheim, Sandoz, Abraxis, Eisai (C/A); Arti Hurria: Amgen, Genentech, GTX (C/A); Celgene (previously Abraxis Bioscience), GlaxoSmithKline (RF); Matti Aapro: None

Reviewer “A”: Roche, Janssen (C/A)

Reviewer “B”: Novartis, Allos (C/A); Novartis, Allos, Pfizer, GlaxoSmithKline (RF)

Figures

Figure 1.
Figure 1.
Chemotherapy regimens: treatment decision flow chart. Abbreviations: ADL, activities of daily living; CEOP, cyclophosphamide, epirubicin, vincristine, and prednisone; CHO, cyclophosphamide, doxorubicin, and vincristine; CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone; CHP, cyclophosphamide, doxorubicin, and prednisone; CVP, cyclophosphamide, vincristine, and prednisone; IADL, instrumental activities of daily living; R, rituximab.
Figure 2.
Figure 2.
Patient survival outcomes.
Figure 3.
Figure 3.
Overall survival times according to prognostic factors. Abbreviation: IPI, International Prognostic Index.
See this image and copyright information in PMC

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References

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