title: Disease characteristics, patterns of care, and survival in very elderly patients with diffuse large B-cell lymphoma.
abstract: BACKGROUND
  Although the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered standard therapy for diffuse large B-cell lymphoma (DLBCL), patterns of use and the impact of R-CHOP on survival in patients aged >80 years are less clear.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to characterize presentation, treatment, and survival patterns in patients with DLBCL who were diagnosed between 2002 and 2009. Chi-square tests compared characteristics and initial treatments among patients with DLBCL who were aged >80 years and ≤80 years. Multivariable logistic regression models examined factors associated with treatment selection in patients aged >80 years; standard and propensity score-adjusted multivariable Cox proportional hazards models examined relationships between treatment regimen, treatment duration, and survival.
  
  
  RESULTS
  Among 4635 patients with DLBCL, 1156 (25%) were aged >80 years. Patients aged >80 years were less likely to receive R-CHOP and more likely to be observed or receive the combination of rituximab, cyclophosphamide, vincristine, and prednisone (P<.0001 for both). Marital status, stage of disease, disease site, performance status, radiotherapy, and growth factor support were associated with initial R-CHOP in patients aged >80 years. In propensity score-matched multivariable Cox proportional hazards models examining relationships between treatment regimen and survival, R-CHOP was the only regimen found to be associated with improved overall survival (hazard ratio, 0.45; 95% confidence interval, 0.33-0.62) and lymphoma-related survival (hazard ratio, 0.58; 95% confidence interval, 0.38-0.88).
  
  
  CONCLUSIONS
  Although patients with DLBCL who were aged >80 years were less likely to receive R-CHOP, this regimen conferred the longest survival and should be considered for this population. Further studies are needed to characterize the impact of treatment of DLBCL on quality of life among patients in this age group.
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Jessica N
authors: JN
authors: Williams
authors: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors: Ashish
authors: A
authors: Rai
authors: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.|Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Joseph
authors: J
authors: Lipscomb
authors: Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Jean L
authors: JL
authors: Koff
authors: Division of Cancer Medicine, Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Loretta J
authors: LJ
authors: Nastoupil
authors: Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Christopher R
authors: CR
authors: Flowers
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 / Q000627:therapeutic use*; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D000069283:Rituximab; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: 80 years and over; aged; diffuse; hematologic neoplasms; large B-cell; lymphoma; treatment outcome