Treatment of Good Prognosis CD20+ Large-Cell Lymphomas in Patients Aged 65 to 80, with 3 Cycles of R-CHOP14 Followed by An Injection of 90Y Ibritumomab Tiuxetan

Background: Treatment of newly diagnosed DLBCL in patients aged 65 to 80 is based on 6 to 8 cycles of R-CHOP at 14 to 21 day intervals. Recent data suggest that for patients with an IPI of 0 or 1, a shorter treatment may be considered. Furthermore, early negative PET-CT results after chemotherapy are an important favourable prognostic factor.

Patients and methods: We propose carrying out two cycles of R-CHOP 14 in patients aged 65 to 80 with newly diagnosed DLBCL and an IPI of 0 or 1. PET-CT will be performed on D28. If the results are normal, an R-CHOP cycle followed by an injection of ibritumomab tiuxetan ⁹⁰Y will be administered. The anticipated total treatment period is 51 days. Ten patients were included from June 2007 to June 2008 (7 women and 3 men), the age-adjusted IPI was 0 and 1 in 6 and 4 cases, respectively. None of the patients had bone marrow involvement and the PS was 0 or 1 in every case.

Results: CT and PET-CT showed complete remission in 9 out of 10 patients, who therefore received the full protocol. The average age was 72 (range, 68–77). The average duration of treatment for these patients was 54 days. As regards to safety, hospitalisation or the prescription of antibiotics was not necessary in any case. No serious adverse event was reported. Mean platelet and leukocyte nadirs were 23,000/mm³ and 1,180/mm³, respectively. Two transfusions of red cell concentrates and one of platelet concentrate were necessary in one patient. To date, all patients are in complete remission.

Conclusion: The treatment regimen of 3 cycles of R-CHOP14 followed by an injection of ⁹⁰Y ibritumomab tiuxetan appears to be tolerated by patients aged 65 to 80 with newly diagnosed DLBCL. Longer follow-up and the inclusion of more patients are necessary to confirm these preliminary data.