title: Comorbidity is an independent prognostic factor in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP: a population-based cohort study.
abstract: An observational population-based cohort study was performed to investigate the role of comorbidity on outcome and treatment-related toxicity in patients with newly diagnosed advanced-stage diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Data for the clinical characteristics of 154 patients (median age 69 years), including Charlson Comorbidity Index (CCI), treatment, toxicity and outcome were evaluated. Forty-five percent of the patients had an International Prognistic index ≥3 and 16% had a CCI ≥2. The planned R-CHOP schedule was completed by 84% and 75% reached complete remission (CR). In those with CCI ≥2, 67% completed treatment with 46% CR. In patients with a CCI <2, overall survival (OS) after 1, 2 and 5 years was 84%, 79% and 65% respectively and it was 64%, 48% and 48% for those with CCI ≥2. Grade III/IV toxicity was documented in 53%, most frequently febrile neutropenia (27%) and infections (23%). In multivariate analysis CCI ≥2 and IPI ≥3 were independent risk indicators for OS and grade III/IV toxicity. In conclusion, comorbidity is an independent risk indicator for worse OS in patients with advanced DLBCL treated with R-CHOP by interference with intensive treatment schedules and more grade III/IV toxicity. Future studies are warranted to determine the optimal treatment approach in patients with significant comorbidities.
authors.affiliation: Department of Pharmacotherapy & Pharmaceutical Care, University Centre for Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: Andre
authors.initials: A
authors.lastname: Wieringa
authors.forename: Karin
authors.initials: K
authors.lastname: Boslooper
authors.forename: Mels
authors.initials: M
authors.lastname: Hoogendoorn
authors.forename: Peter
authors.initials: P
authors.lastname: Joosten
authors.forename: Tim
authors.initials: T
authors.lastname: Beerden
authors.forename: Huib
authors.initials: H
authors.lastname: Storm
authors.forename: Robby E
authors.initials: RE
authors.lastname: Kibbelaar
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Veldhuis
authors.forename: Harmen
authors.initials: H
authors.lastname: van Kamp
authors.forename: Bastiaan
authors.initials: B
authors.lastname: van Rees
authors.forename: Hanneke C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.forename: Nic J G M
authors.initials: NJ
authors.lastname: Veeger
authors.forename: Eric N
authors.initials: EN
authors.lastname: van Roon
mesh_terms: D000328:Adult; 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*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003920:Diabetes Mellitus / Q000453:epidemiology; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007239:Infections / Q000209:etiology; D007674:Kidney Diseases / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: R-CHOP; comorbidity; diffuse large B-cell lymphoma; population-based; toxicity