title: Two sides of the medallion: poor treatment tolerance but better survival by standard chemotherapy in elderly patients with advanced-stage diffuse large B-cell lymphoma.
abstract: BACKGROUND
  We investigated treatment of unselected elderly patients with diffuse large B-cell lymphoma (DLBCL) and its subsequent impact on treatment tolerance and survival.
  
  
  METHODS
  Data from all 419 advanced-stage DLBCL patients, aged 75 or older and newly diagnosed between 1997 and 2004, were included from five regional population-based cancer registries in The Netherlands. Subsequent data on comorbidity, performance status, treatment, motives for adaptations or refraining from chemotherapy and toxic effects was collected from the medical records. Follow-up was completed until 1st January 2009.
  
  
  RESULTS
  Only 46% of patients received the standard therapy [aggressive chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP)-like chemotherapy]. Motives for withholding chemotherapy were refusal by patient/family, poor performance status or estimated short life expectancy. Of all patients receiving CHOP-like chemotherapy, only 56% could complete at least six cycles. Grade 3 or 4 toxicity occurred in 67% of patients receiving standard therapy. The independent effect of therapy on survival remained after correction for the age-adjusted International Prognostic Index.
  
  
  CONCLUSIONS
  Standard therapy was applied less often in elderly patients with a subsequent independent negative impact on survival. Furthermore, high toxicity rate and the impossibility of the majority of patients to complete treatment were seen. This implies that better treatment strategies should be devised including a proper selection of senior patients for this aggressive chemotherapy.
authors.affiliation: Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven.
authors.forename: S A M
authors.initials: SAM
authors.lastname: van de Schans
authors.affiliation: Department of Internal Medicine, Medisch Spectrum Twente, Enschede.
authors.forename: A N M
authors.initials: ANM
authors.lastname: Wymenga
authors.affiliation: Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen; Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Spronsen
authors.affiliation: Department of Internal Medicine, University Hospital Maastricht, Maastricht.
authors.forename: H C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: J W W
authors.initials: JWW
authors.lastname: Coebergh
authors.affiliation: Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands. Electronic address: research@ikz.nl.
authors.forename: M L G
authors.initials: MLG
authors.lastname: Janssen-Heijnen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000592:standards / Q000627:therapeutic use*; D002423:Cause of Death; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012042:Registries / Q000706:statistics & numerical data; D059039:Standard of Care; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone