title: Tailored therapy in an unselected population of 91 elderly patients with DLBCL prospectively evaluated using a simplified CGA.
abstract: BACKGROUND
  Elderly patients with diffuse large B-cell lymphoma (DLBCL) are a heterogeneous population; clinical trials have evaluated a minority of these patients.
  
  
  METHODS
  Ninety-one elderly patients with DLBCL received tailored treatment based on a comprehensive geriatric assessment (CGA). Three groups were identified: I, fit patients; II, patients with comorbidities; III, frail patients. Group I received 21-day cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP-21), group II received R-CHOP-21 with liposomal doxorubicin, and group III received 21-day cycles of reduced-dose CHOP. Fifty-four patients (59%) were allocated to group I, 22 (25%) were allocated to group II, and 15 (16%) were allocated to group III.
  
  
  RESULTS
  The complete response (CR) rates were 81.5% in group I, 64% in group II, and 60% in group III. With a median follow-up of 57 months, 42 patients are alive, with 41 in continuous CR: 31 patients (57%) in group I, seven patients (32%) in group II, and four patients (20%) in group III. The 5-year overall survival, event-free survival, and disease-free survival rates in all patients were 46%, 31%, and 41%, respectively. Multivariate analysis selected group I assignment as the main significant prognostic factor for outcome.
  
  
  CONCLUSIONS
  This approach in an unselected population of elderly DLBCL patients shows that treatment tailored according to a CGA allows the evaluation of elderly patients who are currently excluded from clinical trials.
authors.affiliation: Clinica di Ematologia e Clinica Medica, Università Politecnica delle Marche, Ancona, Italy. a.olivieri@univpm.it
authors.forename: Attilio
authors.initials: A
authors.lastname: Olivieri
authors.forename: Guido
authors.initials: G
authors.lastname: Gini
authors.forename: Caterina
authors.initials: C
authors.lastname: Bocci
authors.forename: Mauro
authors.initials: M
authors.lastname: Montanari
authors.forename: Silvia
authors.initials: S
authors.lastname: Trappolini
authors.forename: Jacopo
authors.initials: J
authors.lastname: Olivieri
authors.forename: Marino
authors.initials: M
authors.lastname: Brunori
authors.forename: Massimo
authors.initials: M
authors.lastname: Catarini
authors.forename: Barbara
authors.initials: B
authors.lastname: Guiducci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Isidori
authors.forename: Francesco
authors.initials: F
authors.lastname: Alesiani
authors.forename: Luciano
authors.initials: L
authors.lastname: Giuliodori
authors.forename: Massimo
authors.initials: M
authors.lastname: Marcellini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visani
authors.forename: Antonella
authors.initials: A
authors.lastname: Poloni
authors.forename: Pietro
authors.initials: P
authors.lastname: Leoni
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D011241:Prednisone