Efficacy and tolerability of rituximab and reduced-dose cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy for elderly patient with diffuse large B-cell lymphoma. Issue 1 (1st January 2019)

• Record Type: Journal Article
• Authors: Kayamori, Kensuke; Shono, Katsuhiro; Onoda, Masahiro; Yokota, Akira
• Is Part Of: Hematology. Volume 24:Issue 1(2019)
• Page Start: 52
• Page End: 59
• Publication Date: 2019-01-01
• Subjects: Elderly patients -- diffuse large B-cell lymphoma -- DLBCL -- CHOP -- R-CHOP -- rituximab -- reduced dose -- toxicity; Blood -- Diseases -- Periodicals; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; 616.15005
• DOI: 10.1080/10245332.2018.1509461
• Languages: English
• ISSNs: 1024-5332

Abstract

ABSTRACT: Objectives: Chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone combined with rituximab (R-CHOP) is currently the first-line therapy for diffuse large B-cell lymphoma (DLBCL). However, management of elderly patients is challenging and often requires dose reductions or prolonged treatment intervals. We investigated the proper dose of R-CHOP for them. Methods: At our institute, for DLBCL patients aged 65–79 and ≥80 years, we had reduced CHOP dose to 5/6 and 7/12, respectively, and retrospectively evaluated the reduced-dose R-CHOP. Results: Although the median age in the standard, 5/6, and 7/12-dose groups was 57, 73, and 84 years, respectively ( p < 0.001), the 3-year event-free survival (EFS) rate did not differ between the standard and 5/6-dose groups (60.2 and 56.7%); however, 7/12-dose group had significantly inferior survival (25.9%). When patients aged 60–80 were evaluated, no difference in EFS was observed between the standard and 5/6-dose groups using the same international prognostic index. The neutrophil nadir and the frequency of infection were comparable among the three dose groups. Discussion and Conclusions: Reduced-dose R-CHOP chemotherapy is a promising treatment for elderly patients with DLBCL in terms of efficacy and toxicity.