Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jun 1;121(11):1800-8.
doi: 10.1002/cncr.29290. Epub 2015 Feb 11.

Disease characteristics, patterns of care, and survival in very elderly patients with diffuse large B-cell lymphoma

Jessica N Williams  1 , Ashish Rai  2 , Joseph Lipscomb  2   3 , Jean L Koff  3 , Loretta J Nastoupil  4 , Christopher R Flowers  3
Affiliations

Disease characteristics, patterns of care, and survival in very elderly patients with diffuse large B-cell lymphoma

Jessica N Williams et al. Cancer. .

Abstract

Background: Although the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered standard therapy for diffuse large B-cell lymphoma (DLBCL), patterns of use and the impact of R-CHOP on survival in patients aged >80 years are less clear.

Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to characterize presentation, treatment, and survival patterns in patients with DLBCL who were diagnosed between 2002 and 2009. Chi-square tests compared characteristics and initial treatments among patients with DLBCL who were aged >80 years and ≤80 years. Multivariable logistic regression models examined factors associated with treatment selection in patients aged >80 years; standard and propensity score-adjusted multivariable Cox proportional hazards models examined relationships between treatment regimen, treatment duration, and survival.

Results: Among 4635 patients with DLBCL, 1156 (25%) were aged >80 years. Patients aged >80 years were less likely to receive R-CHOP and more likely to be observed or receive the combination of rituximab, cyclophosphamide, vincristine, and prednisone (P<.0001 for both). Marital status, stage of disease, disease site, performance status, radiotherapy, and growth factor support were associated with initial R-CHOP in patients aged >80 years. In propensity score-matched multivariable Cox proportional hazards models examining relationships between treatment regimen and survival, R-CHOP was the only regimen found to be associated with improved overall survival (hazard ratio, 0.45; 95% confidence interval, 0.33-0.62) and lymphoma-related survival (hazard ratio, 0.58; 95% confidence interval, 0.38-0.88).

Conclusions: Although patients with DLBCL who were aged >80 years were less likely to receive R-CHOP, this regimen conferred the longest survival and should be considered for this population. Further studies are needed to characterize the impact of treatment of DLBCL on quality of life among patients in this age group.

Keywords: 80 years and over; aged; diffuse; hematologic neoplasms; large B-cell; lymphoma; treatment outcome.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Selection of the study cohort. DLBCL=diffuse large B-cell lymphoma; SEER=Surveillance, Epidemiology, and End Results; HMO=health maintenance organization; CHOP=cyclophosphamide, doxorubicin, vincristine, prednisone; R-CHOP=rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; CVP=cyclophosphamide, vincristine, prednisone; R-CVP=rituximab, cyclophosphamide, vincristine, prednisone.
Figure 2
Figure 2
Overall survival curves (A: all stages, n=4,635; C: stage I/II, n=2,475; E: stage III/IV, n=1,832) and lymphoma-related survival curves (B: all stages, n=4,066; D: stage I/II, n=2,188; F: stage III/IV, n=1,584) by age category among patients initially receiving R-CHOP. OS=overall survival; LRS=lymphoma-related survival; R-CHOP=rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone.
Figure 3
Figure 3
Overall survival curves (A: n=1,133) and lymphoma-related survival curves (B: n=984) for patients greater than 80 years old, by treatment regimen. CHOP=cyclophosphamide, doxorubicin, vincristine, prednisone; R-CHOP=rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; R-CVP=rituximab, cyclophosphamide, vincristine, prednisone; OS=overall survival; LRS=lymphoma-related survival. Patients treated with CVP (cyclophosphamide, vincristine, prednisone) were removed in order to prevent patient identification.
See this image and copyright information in PMC

Comment in

References

    1. Flowers CR, Sinha R, Vose JM. Improving outcomes for patients with diffuse large B-cell lymphoma. CA Cancer J Clin. 2010;60:393–408. - PubMed
    1. Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: a report from the Haematological Malignancy Research Network. Br J Cancer. 2011;105:1684–1692. - PMC - PubMed
    1. Howlader N, Noone AM, Krapcho M, et al. [accessed June 3, 2014];SEER cancer statistics review, 1975–2011. 2013 Available from URL: http://seer.cancer.gov/csr/1975_2011/results_merged/sect_19_nhl.pdf.
    1. United States Census Bureau. [accessed January 19, 2014];Percent distribution of the projected population by selected age groups and sex for the United States: 2015 to 2060. 2012 Table 3. Available from URL: http://www.census.gov/population/projections/data/national/2012/summaryt....
    1. Vincent GK, Velkoff VA. [accessed May 14, 2014];The next four decades: the older population in the United States: 2010 to 2050. 2010 :10. Available from URL: http://www.census.gov/prod/2010pubs/p25-1138.pdf.

Publication types

MeSH terms