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Frontline treatment of older patients with diffuse large B-cell lymphoma (DLBCL) with standard dose R-CHOP was associated with improved real-world progression-free survival (rwPFS) and real-world overall survival (rwOS) compared with reduced dose R-CHOP and nonanthracycline regimens, but only in patients aged 70 to 79 years.
In patients 80 years and older, neither intensity nor type of treatment was associated with differences in rwPFS or rwOS. These results were presented at the ASH Annual Meeting 2023.
This study investigated treatment outcomes of 434 patients 70 years and older with newly diagnosed DLBCL and no history of indolent lymphoma or other cancers in the 2 years prior to frontline therapy. This demographic of older patients constitutes one-third of DLBCL cases, yet their varied treatment plans and outcomes remain under-researched.
In this study, researchers scrutinized the efficacy of different first-line therapy regimens in this cohort of older patients, encompassing reduced dose R-CHOP, standard dose R-CHOP, and alternative regimens without anthracycline.
Median age of the cohort was 79 years, and approximately 14% had no documented therapy. Gender distribution was approximately equal. Half the patients in the cohort received R-CHOP, with different doses and regimens assessed. Rates of complete response were highest in patients receiving standard-dose R-CHOP.
Additionally, patients 70 to 79 years who received standard-dose R-CHOP experienced significant improvements in rwPFS and rwOS. However, treatment intensity did not associate with improvements in rwPFS or rwOS in patients 80 years or older, emphasizing different considerations for regimen selection in octogenarians and beyond receiving frontline therapy for DLBCL.
The outcomes were associated with different factors: in patients 80 years and older, the Charlson Comorbidity Index (CCI) played a role, whereas those 70 to 79 years with a high-risk international prognostic index were affected. This implies that administering standard dose R-CHOP is advisable for patients 70 to 79 years when feasible. Nonetheless, treatment intensity does not significantly impact outcomes in patients 80 years and older. The CCI assessment should be a routine part of evaluating elderly patients with DLBCL.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for the full list of disclosures.
Reference
Narkhede M, Frosch ZA, Chong EA, et al. Treatment intensity and outcomes in elderly patients with DLBCL receiving first line therapy. Presented at ASH Annual Meeting 2023. December 9-12, 2023. San Diego, CA. Abstract 68.
