title: Comparison of Three Chemotherapy Regimens in Elderly Patients with Diffuse Large B Cell Lymphoma: Experience at a Single National Reference Center in Mexico.
abstract: Background. Although chemotherapy added to rituximab is a standard of care for diffuse large B cell lymphoma (DLBCL), treatment of patients ≥65 years of age remains controversial due to comorbidities. Methods. This is a retrospective, comparative, nonrandomized study of patients ≥65 years of age, who were diagnosed with DLBCL but not previously treated. Demographic characteristics and comorbidities were analyzed. Three rituximab-containing treatment regimens (standard RCHOP, anthracycline dose-reduced RChOP, and RCOP) were compared. Descriptive analyses were conducted. Survival was calculated with the Kaplan-Meier method, and differences were compared with the log-rank test. Results. In total, 141 patients with a median age of 73.9 years were studied. The three treatment groups had comparable demographic characteristics. The overall response was 77%, 72.5%, and 59% in groups treated with RCHOP, RChOP, and RCOP, respectively. After multivariate analysis, the factors influencing the overall survival were the presence of B symptoms, poor performance status (ECOG ≥ 3), and febrile neutropenia. Factors influencing disease-free survival were febrile neutropenia, high-intermediate and high-risk IPI scores, and treatment without anthracycline. Conclusion. A higher ORR (overall response rate) was achieved with standard RCHOP, which influenced DFS and OS, although it was not statistically significant compared with the other groups. Interventional phase 3 trials testing new molecules in patients aged 70 to 80 years and older are required to improve the prognosis within this growing population.
authors.affiliation: Hematology Department, Instituto Nacional de Cancerología, 14080 Mexico City, DF, Mexico.
authors.forename: Diana
authors.initials: D
authors.lastname: Nolasco-Medina
authors.affiliation: Clinical Research Division, Instituto Nacional de Cancerología, 14080 Mexico City, DF, Mexico.
authors.forename: Nancy
authors.initials: N
authors.lastname: Reynoso-Noveron
authors.affiliation: Clinical Research Division, Instituto Nacional de Cancerología, 14080 Mexico City, DF, Mexico; Instituto de Investigaciones Biomédicas, UNAM, 04510 Mexico City, DF, Mexico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mohar-Betancourt
authors.affiliation: Pathology Department, Instituto Nacional de Cancerología, 14080 Mexico City, DF, Mexico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Aviles-Salas
authors.affiliation: Nuclear Medicine Department, Instituto Nacional de Cancerología, 14080 Mexico City, DF, Mexico.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: García-Perez
authors.affiliation: Clinical Research Division, Instituto Nacional de Cancerología, 14080 Mexico City, DF, Mexico.
authors.forename: Myrna
authors.identifier: 0000-0002-5478-714X
authors.initials: M
authors.lastname: Candelaria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage* / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D000069283:Rituximab; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D018943:Anthracyclines; D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone