title: Limited stage diffuse large B-cell lymphoma: comparative effectiveness of treatment strategies in a large cohort of elderly patients.
abstract: Optimal treatment for limited stage diffuse large B-cell lymphoma (DLBCL) in the elderly is controversial. Using the Surveillance, Epidemiology and End Results-Medicare database, we compared overall survival (OS), time to second-line therapy (surrogate for recurrence) and adverse events in elderly patients diagnosed with stage I or II DLBCL in 1999-2009, who received either abbreviated rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) plus radiation or 6-8 cycles of RCHOP alone. Of 874 patients, 359 received abbreviated RCHOP with radiation, and 515 received a full course of RCHOP. In propensity score-adjusted analyses, OS was similar in both groups (hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.76, 1.38). Abbreviated RCHOP with radiation was associated with lower risk of second-line therapy (HR 0.71, 95% CI 0.53, 0.94) and lower odds of febrile neutropenia (odds ratio [OR] 0.27, 95% CI 0.15, 0.50). While the two treatments resulted in similar survival, our data suggest that abbreviated RCHOP with radiation may be better tolerated than a full course of RCHOP.
authors.affiliation: Division of Population Sciences, Dana-Farber Cancer Institute , Boston, MA , USA.
authors.forename: Oreofe O
authors.initials: OO
authors.lastname: Odejide
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.forename: Ann S
authors.initials: AS
authors.lastname: LaCasce
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000209:etiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods*; D000069283:Rituximab / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Diffuse large B-cell lymphoma; comparative effectiveness; elderly; rituximab