title: What determines therapeutic choices for elderly patients with DLBCL? Clinical findings of a multicenter study in Portugal.
abstract: BACKGROUND
  Age is a negative prognostic factor in lymphomas, and elderly patients are often undertreated because of toxicity concerns. The pattern of treatment in elderly patients with diffuse large B-cell lymphoma (DLBCL) in Portugal has not been previously described.
  
  
  METHODS
  We conducted a multicenter retrospective study including 378 elderly patients with DLBCL receiving alkylating agent-containing regimens between 2003 and 2010. We compared the outcome of patients aged 60 to 79 years with patients > 79 years and analyzed the second group according to treatment.
  
  
  RESULTS
  R-CHOP (rituximab, cyclophosphamide, doxorubicin [hydroxydaunorubicin], vincristine [Oncovin], prednisolone) was prescribed in only 60% of patients and was prescribed significantly less in patients > 79 years, despite no significant differences being found in comorbidities between the 2 age groups. Similarly, dose reductions frequently were instituted because of chronologic age and not always because of toxicity. When different regimens were compared, multivariate analysis showed an independent beneficial effect of R-CHOP in treatment outcomes. Additionally, treatment with anthracyclines and rituximab predicted a better progression-free survival (PFS) and time to progression (TTP) in patients > 79 years.
  
  
  CONCLUSIONS
  This was the first characterization of the clinical care of elderly Portuguese patients with DLBCL. We showed that R-CHOP is effective even in patients > 79 years, emphasizing that treatment decisions based on age alone can compromise treatment efficacy and outcome in fit patients.
authors.affiliation: Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal. Electronic address: rutealv@gmail.com.
authors.forename: Rute
authors.initials: R
authors.lastname: Alvarez
authors.affiliation: Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Esteves
authors.affiliation: Instituto Português de Oncologia do Porto de Francisco Gentil, Porto, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Chacim
authors.affiliation: Hospital Universitário de Coimbra, Coimbra, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Carda
authors.affiliation: Hospital de Santo António, Porto, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Mota
authors.affiliation: Hospital São João, Porto, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Guerreiro
authors.affiliation: Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Barbosa
authors.affiliation: Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Moita
authors.affiliation: Hospital Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Adriana
authors.initials: A
authors.lastname: Teixeira
authors.affiliation: Hospital de Santo António, Porto, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Coutinho
authors.affiliation: Hospital São João, Porto, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Príncipe
authors.affiliation: Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal.
authors.forename: José Mário
authors.initials: JM
authors.lastname: Mariz
authors.affiliation: Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal.
authors.forename: Maria Gomes
authors.initials: MG
authors.lastname: Silva
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003657:Decision Making; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011174:Portugal / Q000453:epidemiology; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D012074:Remission Induction; D012120:Respiration Disorders / Q000453:epidemiology; D012189:Retrospective 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
keywords: DLBCL; Elderly; R-CHOP; Treatment