Prognostic Factors and Treatment Results in Elderly Patients with Aggressive B-Cell Lymphoma: A Geltamo Observational Study

Introduction: Diffuse large B-cell lymphoma (DLBCL) is one of the most common malignant neoplasms in elderly patients, potentially curable when optimum treatment is administered. The combination of rituximab with CHOP chemotherapy (R-CHOP) is considered standard for these patients, but randomized studies published to date are limited to the range of age from 60 to 80 years, so that in patients over this age treatment election is not so clear, usually opting for palliative treatment or a "full" treatment at a reduced dose. This retrospective study is primarily aimed to analyze the influence of the type of treatment and comorbidity scales in overall survival (OS) of a large series of patients >80 years with aggressive B-cell lymphoma.

Methods: Eligible patients were aged ≥ 80 years, diagnosed of DLBCL, follicular lymphoma grade 3B or transformed lymphoma. The main patient characteristics were obtained retrospectively from the medical records, including a complete geriatric assessment (CGA, "comprehensive geriatric assessment") and the Charlson comorbidity index. The Ethics Committee of the University Hospital of Salamanca approved the study.

Results: 288 patients from 19 GELTAMO hospitals were registered in the study, of which 234 (60% women) were evaluable and have been included in this preliminary analysis. The median age was 84 years (80-94) and the vast majority (94%) were DLBCL. According to the Charlson index, 65% of patients were low-intermediate risk, and according to CGA, 63% of patients were considered "fit". A higher proportion (60% v 44%, p = 0.03) of patients with low or intermediate comorbidity index were treated with a curative intent (CHOP +/- rituximab), as compared with patients with high or very high index. With a median follow up of 41 (range 9-142) months, the median OS was 11.5 months (33% estimated at 3 years). The median OS for patients treated with R-CHOP-like (N=96) was 35.3 months, significantly better (p <0.001) than those achieved with CHOP-like (n=23, 7.9 months), R-CVP (n=20, 6.9 months) or cyclophosphamide- prednisone +/- vincristine (n=69, 6.2 months). Charlson comorbidity index and CGA scale also had a significant influence on OS (median of 14.6 vs. 6.1 months for patients with low or intermediate versus high or very high risk, p = 0.006; and 18 vs 6.6 months for patients "fit" versus "non-fit", p = 0.006). In the multivariate analysis, treatment with R-CHOP-like (RR = 0.4; 95% CI: 0.3-0.6) and IPI <3 (RR = 0.4; 95% CI: 0.3-0.6) had an independent positive influence on OS.

Conclusions: In patients over 80 years with DLBCL, treatment with R-CHOP-like was associated with the best results in terms of OS. Therefore, its administration must be considered whenever possible.