Abstract
Background: Chemoimmunotherapy is the standard of care for the frontline treatment of DLBCL. However, elderly patients may have comorbidities that require modifications such as dose reductions or the omission of some drugs, such as anthracyclines.
Methods: Herein, we report a retrospective analysis of patients 80 years or older, with a pathological diagnosis of DLBCL treated at different institutions in Latin America. Demographic characteristics are reported using descriptive statistics. All patients received treatment; those who completed 6 cycles and underwent either CT or PETCT at the end of therapy were considered evaluable for response. Logistic and Cox proportional-hazard regression models were fitted to evaluate parameters associated with response and survival. Survival curves were estimated using the Kaplan-Meier method.
Results: 183 patients were included, of whom 95 (52%) were male, with a median age 84 years (range 80-97). 139 patients (76%) reported at least one comorbidity. The most frequent comorbidity was diabetes mellitus (DM) (n=96, 53%), either alone (n=40, 22 %), or associated to arterial hypertension (n=38, 21%), ischemic cardiopathy (n=5, 3%), dyslipidemia (n=15, 8%), or hypothyroidism (n=2, 1%). The most common secondary malignancies reported were prostate cancer, breast cancer, and gastric cancer (n=1, each, 0.5%). 141 patients (77%) had performance status ECOG 0-2, 108 (59%) had an advanced stage (Lugano III-IV), 60 (33%) had bulky disease (>7 cm), and 91 (50%) had extranodal disease. The most frequent extranodal site involved was the kidney (n=19, 21%). Regarding biochemical parameters, 36 (20%) had albumin <3 g/dL and 82 (45%) had elevated LDH. All patients received treatment: 75 (41%) had R-miniCHOP, 44 (24 %) had R-CHOP with a reduction in anthracycline dose, and 64 (35 %) received full dose R-CHOP. 48 patients (26%) were hospitalized because of febrile neutropenia (n=28, 15%), uncontrolled comorbidities (n=17, 9%), or hemorrhage (n=3, 2%). 27 patients (15%) required transfusion of blood products (red blood cells [n=15, 8%], platelets [n=2, 1%], and both [n=10, 5%]). Although all patients were treated with a curative intent, 50 (27%) did not complete the planned therapy because of toxicity or lymphoma progression. Therefore, response to therapy was evaluated in 133 patients. 72 patients (54%) attained a complete response and 20 (15%) attained a partial response. Advanced stage (45 % vs 56 % in localized disease, p=0.04) and ECOG ≥2 (37 % vs 71 % for ECOG 0-1, p= 0.001) were associated with lower rates of complete response. With a median follow up of 39 months (95% CI 7-70), there were 87 deaths. Causes of death were: therapy-related (n= 43, 23%), lymphoma progression (n= 33, 18%), and comorbidities (n=11, 6%). No differences in response or survival were detected between patients treated with R-miniCHOP or those with dose reduction of anthracyclines. The 5-year overall survival in treated patients was 46 %. The median and 5-year overall survival rates were 80 months (95% CI 63-96) and 60% vs 5 months (95 % CI: 3-6) and 18% in patients who did and did not complete treatment, respectively (p<0.001).
Conclusions: This real-world analysis shows that in Latin America, elderly patients with DLBCL had survival rates comparable to previous reports. DM was the main comorbidity in this patient population. Febrile neutropenia (26%) was the main cause of hospitalization with 23% of deaths related to toxicity. Complete responses were seen in 54% of patients with longer survival in those who completed their planned regimen. We are currently enrolling patients through the Epidemiology of Lymphomas in Latin America (ELLA) cohort study to assess epidemiological, biological, and therapy factors with impact on survival in this distinct patient population.
Disclosures
Oliver:Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Agencia Nacional De Investigacion e innovacion: Research Funding; Janssen: Speakers Bureau; Nolver: Membership on an entity's Board of Directors or advisory committees; Roche: Speakers Bureau. Castillo:Janssen: Consultancy; Roche: Consultancy; Pharmacyclics: Consultancy, Research Funding; Cellectar: Consultancy; Beigene: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding; TG Therapeutics: Research Funding; AstraZeneca: Research Funding.
