title: Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma.
abstract: Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or de-escalate therapy, thereby reducing toxicity, with consequent risks for under- or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B-cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores. Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow-up of 64 months, 51 patients were alive, with 5-year disease-free, overall, and cause-specific survival rates of 80%, 60%, and 74%, respectively. Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA-driven treatment may result in better cure rates, especially in fit and unfit patients.
authors.affiliation: Division of Medical Oncology A, National Cancer Institute, Via Franco Gallini 2, Aviano, PN, Italy. mspina@cro.it
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.forename: Monica
authors.initials: M
authors.lastname: Balzarotti
authors.forename: Lilj
authors.initials: L
authors.lastname: Uziel
authors.forename: Andrés José Marìa
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: Lucia
authors.initials: L
authors.lastname: Fratino
authors.forename: Massimo
authors.initials: M
authors.lastname: Magagnoli
authors.forename: Renato
authors.initials: R
authors.lastname: Talamini
authors.forename: Annalisa
authors.initials: A
authors.lastname: Giacalone
authors.forename: Elena
authors.initials: E
authors.lastname: Ravaioli
authors.forename: Emanuela
authors.initials: E
authors.lastname: Chimienti
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Berretta
authors.forename: Arben
authors.initials: A
authors.lastname: Lleshi
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.forename: Umberto
authors.initials: U
authors.lastname: Tirelli
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D009503:Neutropenia / Q000188:drug therapy / Q000209:etiology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone