title: Analysis of elderly patients with diffuse large B-cell lymphoma: aggressive therapy is a reasonable approach for 'unfit' patients classified by comprehensive geriatric assessment.
abstract: BACKGROUND
  The treatment strategy for diffuse large B-cell lymphoma (DLBCL) in elderly patients is problematic. Although several researchers have reported the effectiveness of comprehensive geriatric assessment (CGA) and the futility of curative treatment in 'unfit' patients with DLBCL, these propositions are not firmly established.
  
  
  METHODS
  We conducted a retrospective analysis using a database. Patients with DLBCL were eligible if ≧ 60 yr old. CGA stratification was performed using medical records.
  
  
  RESULTS
  One hundred and 35 patients were identified. Anthracycline-based chemotherapy with curative intent was performed in 115 (85%) patients. According to CGA, 82 (61%) patients were classified as 'fit'. Their 1-yr overall survival (OS) was significantly better than that of 'unfit' patients [91.3% vs. 53.8%, P < 0.001]. Patients classified as 'unfit' treated with curative intent had a significantly better 1-yr OS when compared with those receiving palliative measures [66.1% vs. 19.0%, P < 0.001].
  
  
  CONCLUSIONS
  CGA is an effective tool for predicting outcomes in older patients with DLBCL. The patients treated with curative intent had significantly better outcomes compared with those receiving palliation, irrespective of CGA stratification. Curative treatment should be considered even for 'unfit' patients.
authors.affiliation: Department of Haematology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Haematology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Nakao
authors.affiliation: Department of Haematology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Mirei
authors.initials: M
authors.lastname: Horiuchi
authors.affiliation: Department of Haematology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Hideya
authors.initials: H
authors.lastname: Ueda
authors.affiliation: Department of Haematology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Hagihara
authors.affiliation: Department of Haematology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kanashima
authors.affiliation: Department of Pathology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Haematology, Shitennoji Hospital, Osaka, Japan.
authors.forename: Erina
authors.initials: E
authors.lastname: Sakamoto
authors.affiliation: Department of Haematology, Shitennoji Hospital, Osaka, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Hirai
authors.affiliation: Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Koh
authors.affiliation: Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nakane
authors.affiliation: Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
authors.affiliation: Department of Haematology, Osaka City General Hospital, Osaka, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D018579:Patient Selection; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: comprehensive geriatric assessment; diffuse large B-cell lymphoma; elderly