title: R-CVP regimen is active in frail elderly patients aged 80 or over with diffuse large B cell lymphoma.
abstract: Patients aged 80 or over with diffuse large B cell lymphoma (DLBCL) often have comorbidities that increase drug toxicity and prevent the use of otherwise optimal treatment. We performed a retrospective analysis of 43 patients aged 80 or over (median age: 83; range: 80-93) unable to receive treatment with anthracyclines, at diagnosis of DLBCL, treated with an R-CVP treatment (standard R-CHOP without doxorubicin). The patients had one or more comorbidities: 18 patients (41.9 %) had a performance status (PS) of 3; 23 patients (53.5 %) had low creatinine clearance; 12 patients (27.9 %) had low left ventricular ejection fraction; seven patients (16.3 %) had poor hepatic function; and 26 patients (60.5 %) had a Charlson index score ≥4. Thirty patients (70 %) had two or three adverse factors according to the age-adjusted International Prognostic Index. Twenty-five patients (58.1 %) received eight cycles of R-CVP, but the full eight cycles could not be given to 18 patients (41.9 %). The OR rate was 58.1 % (CR 37.2 %). There were 34 deaths (79 %) during treatment and follow-up. Ten patients (23.3 %) died early from toxicity before interim evaluation; all had PS 3. The median follow-up of surviving patients was 52.6 months. The overall 2-year survival rate was 31.9 % and the median OS was 12.6 months. The median OS for patients who completed the entire treatment was 26.4 months. The median PFS was 11.2 months. In multivariate analyses, OS was only affected by performance status ≥2 and Charlson index score ≥4. The R-CVP regimen can be active in elderly frail patients aged 80 or more with DLBCL, but systematic geriatric assessment is required so that those unsuitable for chemotherapy are excluded.
authors.affiliation: Department of Hematology, Centre Hospitalier du Mans, Le Mans, France. klaribi@ch-lemans.fr.
authors.forename: Kamel
authors.initials: K
authors.lastname: Laribi
authors.affiliation: Department of Hematology, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Denizon
authors.affiliation: Department of Pharmacy, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Bolle
authors.affiliation: Clinical research center, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Truong
authors.affiliation: Department of Hematology, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Besançon
authors.affiliation: Laboratory of Anatomopathology, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sandrini
authors.affiliation: Department of Hematology, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Andreaa
authors.initials: A
authors.lastname: Anghel
authors.affiliation: Department of Hematology, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Farhi
authors.affiliation: Department of Hematology, Centre Hospitalier du Mans, Le Mans, France.
authors.forename: Habib
authors.initials: H
authors.lastname: Ghnaya
authors.affiliation: Department of Medicine, Pôle Santé Sud, Le Mans, France.
authors.forename: Alix
authors.initials: A
authors.lastname: Baugier de Materre
mesh_terms: D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D016330:Frail Elderly; D006402:Hematologic Diseases / Q000139:chemically induced; D006801:Humans; D007239:Infections / Q000209:etiology; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000139:chemically induced; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage / Q000009:adverse effects; D016879:Salvage Therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Comorbidity; DLBCL; Elderly; Frailty; Performance status; R-CVP