title: Outcomes of very elderly patients with aggressive B-cell non-Hodgkin lymphoma treated with reduced-dose chemotherapy.
abstract: BACKGROUND
  Although the number of patients aged 80 years or older with aggressive B-cell non-Hodgkin lymphoma (B-NHL) has increased in the clinical setting, management has been challenging due to lower tolerability. The aim of the present study was to evaluate the efficacy and safety of reduced-dose chemotherapy for very elderly patients.
  
  
  METHODS
  We retrospectively analyzed the clinical outcomes of patients aged ≥80 years old with diffuse large B-cell lymphoma (n = 58) or grade 3 follicular lymphoma (n = 3).
  
  
  RESULTS
  Patient ages ranged from 80 to 93 years old, with a median of 83 years old. Twenty-four patients were treated with CHOP or THP-COP, the dosages of which were variably reduced, in combination with rituximab (R-vCHOP), while another 24 patients were treated with R-miniCHOP. Twelve R-vCHOP and 16 R-miniCHOP patients completed the chemotherapy cycles. The estimated 2-year progression-free and overall survival rates in the R-vCHOP and R-miniCHOP groups were 53 and 39 % (P = 0.92) and 53 and 48 % (P = 0.95), respectively. Performance status ≥2, lactate dehydrogenase level >normal, serum albumin ≤3.5 g/dL, C-reactive protein ≥2.0 mg/dL, age-adjusted International Prognostic Score 2/3, and withdrawal from the chemotherapy cycle were associated with poor survival. The frequency of chemotherapy-related hospitalization during the second or later cycles was significantly less in the R-miniCHOP group.
  
  
  CONCLUSIONS
  The efficacies of R-vCHOP and R-miniCHOP were similar in patients aged ≥80 years old with aggressive B-NHL. The reduced frequency of hospitalization observed for R-miniCHOP treatment is beneficial for very elderly patients.
authors.affiliation: Department of Hematology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan. iioka@tenriyorozu.jp.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Iioka
authors.affiliation: Department of Hematology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Hematology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kamoda
authors.affiliation: Department of Hematology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Department of Hematology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ohno
mesh_terms: 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; D002097:C-Reactive Protein / Q000378:metabolism; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000188:drug therapy*; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage / Q000009:adverse effects; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D028761:Withholding Treatment
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D012709:Serum Albumin; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D002097:C-Reactive Protein; D011239:Prednisolone; D007770:L-Lactate Dehydrogenase; D011241:Prednisone
keywords: Aggressive B-cell non-Hodgkin lymphoma; Chemotherapy-related hospitalization; R-miniCHOP; Very elderly patients