The Prognostic Impact of Dose-attenuated R-CHOP Therapy for Elderly Patients with Diffuse Large B-cell Lymphoma

Abstract

Objective Although R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone) is a standard therapy for diffuse large B-cell lymphoma (DLBCL), the optimal dose for elderly patients remains unclear. Methods and Patients We retrospectively verified our R-CHOP dose-attenuation system implemented from 2005 for DLBCL patients. Among the 115 DLBCL patients treated during 2001-2010, 33 patients treated during 2001-2005 received R-CHOP doses adjusted according to physicians' decisions (PHY group). Eighty-two patients treated after 2005 received adjusted R-CHOP doses according to a unified dose-attenuation system (UNI group). Patients aged <60, 60-69, 70-79, and ≥80 years received the standard R-CHOP, 100% R-CHO+P (50 mg/m²), 100% R+75% CHO+P (40 mg/m²), and 100% R+50% CHO+P (30 mg/m²), respectively. We compared the responses, survival, and treatment cessation between the PHY and UNI groups. Results The patients' characteristics between both groups were closely comparable. All PHY patients received randomly adjusted R-CHOP doses; 94% of UNI patients received scheduled doses. The complete response rates differed significantly between the UNI (77%) and PHY patients (50%) (p=0.011). The two-year event-free survival rates were 50% and 32% in the UNI and PHY groups, respectively (p=0.0083). The two-year OS rates were 77% and 72% in the UNI and PHY group (p=0.16). Among the patients aged >70 years (n=59) overall survival was shorter in the PHY group (62%) than in the UNI group (72%; p=0.02). The UNI group received higher anti-tumor agent doses than the PHY group. The therapy discontinuation rates were 5% in the UNI group and 24% in the PHY group. Conclusion Carrying out unified dose reduction may improve the efficacy and prognosis among elderly DLBCL patients.

Keywords: DLBCL; R-CHOP; comorbidities; dose-attenuation; elderly.

Figure 1.

Event-free and overall survival according to the treatment group Event-free survival. (a) and overall survival (b) in the 115 patients. 2-year EFS are 50% (UNI) and 32% (PHY), and 2-year OS are 77% (UNI) and 72% (PHY). PHY: physicians’ decision group, UNI: unified dose-attenuation group

Figure 2.

Event-free and overall survivals of 59 patients aged ≥70 years according to the treatment group. Event-free survival (a) and overall survival (b) in the 59 patients older than 70 years. 2-year EFS are 50% (UNI) and 0% (PHY), and 2-year OS are 72% (UNI) and 62% (PHY). PHY: physicians’ decision group, UNI: unified dose-attenuation group

Figure 3.

Overall survival according to patient age in each treatment group. (a) Overall survival according to patient age in the PHY group. (b) Overall survival according to patient age in the UNI group. PHY: physicians’ decision group, UNI: unified dose-attenuation group