Background:

Incidence of Diffuse Large B-Cell Lymphoma (DLBCL), one of the most common lymphoid malignancies worldwide, increases with age. With improving life expectancy, its incidence among the elderly population is predicted to rise further. Elderly patients pose unique challenges- multiple co-morbidities, variable life expectancy, poor social support systems, and increased risk of therapy-related toxicity. Management decisions in geriatric patients are usually based on data obtained in younger patients. R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone) is the standard chemotherapy for younger patients with DLBCL. Unfortunately, among the patients aged 80 or more, data on the use of R-CHOP and its comparison with other treatment regimens are meager. Also, new data on alternate chemotherapy regimens including R with Bendamustine (R-Benda) and R with low dose CHOP (R-miniCHOP) are emerging. Thus, there is a need for development and validation of treatment strategies for DLBCL in this patient population. Objective of this study is to provide a descriptive data including co-morbidity profile, chemotherapy regimen offered, tolerance of chemotherapy, and outcome of the treatment among the DLBCL patients aged 80 or more.

Methodology:

A retrospective chart review of 33 DLBCL patients (N) aged 80 or more treated in the last 4 years in a tertiary community hospital.

Results:

Table 1
AgeCharlson
Co-morbidity Index (CCI)		Serum Lactate DehydrogenaseSerum AlbuminSerum Beta2 MicroglobulinMedian Ki67
Valid N 33 30 23 24 9 11 
Mean 83.33 2.87 611.91 2.85 6.77 0.70 
Median 83.00 2.00 302 2.95 4.85 0.75 
Standard Deviation 5.50 1.94 1033.15 0.78 5.79 0.19 
Minimum 69 0 84 1.60 1.90 0.40 
Maximum 93 9 5038 4.20 19.70 0.95 
AgeCharlson
Co-morbidity Index (CCI)		Serum Lactate DehydrogenaseSerum AlbuminSerum Beta2 MicroglobulinMedian Ki67
Valid N 33 30 23 24 9 11 
Mean 83.33 2.87 611.91 2.85 6.77 0.70 
Median 83.00 2.00 302 2.95 4.85 0.75 
Standard Deviation 5.50 1.94 1033.15 0.78 5.79 0.19 
Minimum 69 0 84 1.60 1.90 0.40 
Maximum 93 9 5038 4.20 19.70 0.95 
View Large

Table 2
ECOG Performance ScoreInternational Prognostic Index (IPI)BMIHemoglobinPlateletsWBCANC
Valid N 25 16 8 31 30 31 28 
Mean 2.16 2.56 25.70 11.58 240.73 8.73 5971 
Median 2.00 3.00 25.95 11.60 201 8.20 5400 
Standard Deviation 1.17 1.03 2.910 1.94 129.64 3.47 2935 
Minimum 0 1 20.98 8.20 62 3.60 1400 
Maximum 4 4 29.40 15.10 716 16.10 12800 
ECOG Performance ScoreInternational Prognostic Index (IPI)BMIHemoglobinPlateletsWBCANC
Valid N 25 16 8 31 30 31 28 
Mean 2.16 2.56 25.70 11.58 240.73 8.73 5971 
Median 2.00 3.00 25.95 11.60 201 8.20 5400 
Standard Deviation 1.17 1.03 2.910 1.94 129.64 3.47 2935 
Minimum 0 1 20.98 8.20 62 3.60 1400 
Maximum 4 4 29.40 15.10 716 16.10 12800 
View Large

Table 3
Valid NCategoriesPercentage
Sex 33 Male
Female 		54.5
45.5 
Prior Malignancy 33 No
Yes 		81.8
18.2 
Ann Arbor Staging 22 1
2
3
4 		22.7
18.2
22.7
36.4 
B symptoms 29 No
Yes 		62.1
37.9 
Node Status 33 Nodal
Extranodal
Nodal and Extranodal 		6.1
42.4
51.5 
Chemotherapy offered 28 No
Yes 		17.9
82.1 
Intent of Therapy 20 Curative
Palliative 		85
15 
Chemotherapy regimen 22 R-miniCHOP
R
R-Bendamustine
R-CHOP
RCVP
RCNOP 		22.7
9
18.18
36.36
9
4.54 
Adverse effect of Chemotherapy 16 No
Yes 		18.75
81.25 
Hospital admission during Chemotherapy 19 No
Yes 		47.36
52.63 
Growth factors required during Chemotherapy 20 No
Yes 		25
75 
Dose delay 17 No
Yes 		70.58
29.42 
Dose modification 17 No
Yes 		64.70
35.29 
Chemotherapy stopped prior to completion 18 No
Yes 		66.67
33.33 
Radiation therapy 19 No
Yes 		52.63
47.36 
Result of chemotherapy 15 Complete Response (CR)
Partial Response (PR)
Progression 		40
40
20 
Relapse 7 No
Yes 		57.14
42.85 
Death 10 No
Yes 		20
80 
Valid NCategoriesPercentage
Sex 33 Male
Female 		54.5
45.5 
Prior Malignancy 33 No
Yes 		81.8
18.2 
Ann Arbor Staging 22 1
2
3
4 		22.7
18.2
22.7
36.4 
B symptoms 29 No
Yes 		62.1
37.9 
Node Status 33 Nodal
Extranodal
Nodal and Extranodal 		6.1
42.4
51.5 
Chemotherapy offered 28 No
Yes 		17.9
82.1 
Intent of Therapy 20 Curative
Palliative 		85
15 
Chemotherapy regimen 22 R-miniCHOP
R
R-Bendamustine
R-CHOP
RCVP
RCNOP 		22.7
9
18.18
36.36
9
4.54 
Adverse effect of Chemotherapy 16 No
Yes 		18.75
81.25 
Hospital admission during Chemotherapy 19 No
Yes 		47.36
52.63 
Growth factors required during Chemotherapy 20 No
Yes 		25
75 
Dose delay 17 No
Yes 		70.58
29.42 
Dose modification 17 No
Yes 		64.70
35.29 
Chemotherapy stopped prior to completion 18 No
Yes 		66.67
33.33 
Radiation therapy 19 No
Yes 		52.63
47.36 
Result of chemotherapy 15 Complete Response (CR)
Partial Response (PR)
Progression 		40
40
20 
Relapse 7 No
Yes 		57.14
42.85 
Death 10 No
Yes 		20
80 
View Large

ANOVA was used for data analysis. A statistically significant difference in mean CCI between those who completed planned chemotherapy course (2.00) and those who did not (4.75) was observed (p= 0.017). Similarly, difference in the mean CCI among those achieving CR (2.00), PR (2.17) and Progression (7.00) was statistically significant (p= 0.005). There were significant differences in the mean pre-chemotherapy ECOG PS between those who completed planned chemotherapy course (1.27) vs. those who did not (2.75), (p= 0. 001) and those achieving CR (1.60), PR (1.00) and progression (3.00), (p=0.012). No significant association was found between CCI or pre-chemotherapy ECOG PS with various factors like type of chemotherapy offered, incidence of adverse effects, and dose delay/modification.

Conclusion:

Very elderly patients (≥80 years) with DLBCL having good ECOG PS or lower CCI are more likely to complete planned chemotherapy course and achieve remission. CCI might be a good marker for evaluation of co-morbidities in very elderly patients and could serve as a predictive tool for patient outcomes. We intend to analyze data of DLBCL patients aged 65 – 79 years and perform comparative study with existing cohort.

Disclosures

No relevant conflicts of interest to declare.

Topics:
diffuse large b-cell lymphoma, older adult, chemotherapy regimen, electrocorticogram, r-chop, adverse effects, bendamustine, extranodal disease, beta 2-microglobulin, cancer

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2014 by The American Society of Hematology
2014
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