Dose Of Vincristine didn’t Predict Outcome Of Treatment For Elderly DLBCL Patients Introductions

Diffuse large B-cell lymphoma (DLBCL) is one of the aggressive type of non-Hodgkin lymphoma (NHL) and is known to have a good drug-sensitivity and prognosis. More than 40% of patients with DLBCL are older than 70 years old at diagnosis, and age is known as a poor prognostic factor. However, dose modification is frequently necessary due to their comorbidities and organ function decline, and this leads to poor outcome of their treatment. Therefore, it is important to optimize treatment strategy and chemotherapy for the elderly with DLBCL to improve their outcome.

The aim of this study is to unveil underlying problems in the treatment against elderly patients with DLBCL and develop a new therapeutic approach to overcome them.

The medical records of all new elderly patients (70 years old< ) with DLBCL between 2003 April and 2011 October at Nagoya Medical Center were reviewed for a retrospective analysis , to identify characteristics and treatment response of those patients. Survival of patients intensively treated (82 pts) was evaluated using Kaplan-Meier method, and analyzed using Log-rank test.

We experienced new 93 patients aged over 70 years (41.9 % of all DLBCL cases). Median observation period of was 52.7 months. R-CHOP and R-CHOP-like regimes were administrated into 78 and 4 patients respectively. Four patients treated without rituximab due to patients’ decision. CR was obtained in 70 patients (CR rate 85.3%), and 3-yr OS and PFS were 72.2% and 72.1% respectively. Eleven patients died during induction chemotherapy or didn’t obtain CR and eventually died. The median doses of ADR, CPM, and VCR were 69.51±15.2%, 70.23±20.0% and 59.1±28.1% of original regimen, respectively.% of VCR to original CHOP regimen was significant different between age 70-79 and age more than 80 (p<0.0001), but OS by % of actual dose VCR to original CHOP was not different (50%< vs. ≧50%, p=0.62), suggesting that dose of VCR didn’t predict outcome of treatment. It might suggest that dose of VCR could be reduced with keeping treatment outcome to improve QOL of survivors who suffer from peripheral neuropathy.

No relevant conflicts of interest to declare.