A retrospective analysis of real-world outcomes of elderly Chinese patients with diffuse large B-cell lymphoma

Abstract

Background: Elderly patients with diffuse large B-cell lymphoma (DLBCL) have a worse prognosis than younger patients, and the optimal treatment strategy for this group remains controversial. We conducted a retrospective analysis to investigate the clinical features and outcomes of elderly patients (>60 years) and to assess the impact of clinical and molecular factors on outcome in this age group.

Methods: From April 2006 to December 2012, a total of 349 elderly patients with DLBCL from the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College were included in this analysis. Patients were further divided into two age groups (61-69 years and ≥70 years). We compared clinical characteristics and outcomes between groups.

Results: Of 349 total patients, 204 (58.5%) were aged 61 to 69 years, and 145 (41.5%) patients were aged 70 years or older. Except for the Eastern Cooperative Oncology Group performance status, clinical characteristics were comparable between the two groups. With a median follow-up of 82 (range, 1-129) months, the 5-year overall survival (OS) and progression-free survival (PFS) rates were 51.9% and 45.8%, respectively. The 5-year OS rates for patients aged 61 to 69 years and those over 70 years were 58.3% and 42.8% (P = 0.007), respectively, and the 5-year PFS rates were 51.0% and 38.6% (P = 0.034). Treatment regimens including rituximab provided a higher 5-year OS rate (63.1% vs. 37.1%, P < 0.001) and PFS rate (56.6% vs. 31.8%, P < 0.001) than chemotherapy alone. For patients aged 61 to 69 years, chemotherapy plus rituximab resulted in a higher 5-year OS rate (66.7% vs. 46.4%, P = 0.002) and PFS rate (60.0% vs. 38.1%, P = 0.002) than chemotherapy alone. For patients aged ≥70 years, there was a marked survival advantage in patients who received chemotherapy plus rituximab (5-year OS rate: 57.7% vs. 25.4%, P < 0.001; 5-year PFS rate: 51.3% vs. 23.9%, P < 0.001) compared with that seen in those who received chemotherapy alone. Multivariate analysis established that stage III/IV disease, elevated lactate dehydrogenase (LDH), initial treatment, and chemotherapy with rituximab were independent risk factors for 5-year OS, and stage III/IV disease, elevated LDH, and chemotherapy with rituximab were independent risk factors for 5-year PFS for elderly patients with DLBCL.

Conclusions: In comparison to patients aged 61 to 69 years, those aged ≥70 years have poorer survival. Prolonged survival is obtainable with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-like in elderly Chinese patients in all age groups, indicating that the R-CHOP-like regimen should be considered for this population, even for those aged 70 years or older.

Figure 1

OS (A) and PFS (B) for elderly patients with diffuse large B-cell lymphoma. OS: Overall survival; PFS: Progression-free survival.

Figure 2

OS (A) and PFS (B) for elderly patients with diffuse large B-cell lymphoma according to age. OS: Overall survival; PFS: Progression-free survival.

Figure 3

OS (A) and PFS (B) for elderly patients according to the treatment regimen. OS: Overall survival; PFS: Progression-free survival; R-CHOP: Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.

Figure 4

OS (A) and PFS (B) for 204 patients aged 61 to 69 years according to the treatment regimen. OS: Overall survival; PFS: Progression-free survival; R-CHOP: Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.

Figure 5

OS (A) and PFS (B) for 145 patients aged ≥70 years according to the treatment regimen. OS: Overall survival; PFS: Progression-free survival; R-CHOP: Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.