1. Treatment option of bendamustine in combination with rituximab in elderly and frail patients with aggressive B-non-Hodgkin lymphoma: rational, efficacy, and tolerance
- Author
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Julia Horn, Monika Engelhardt, Annette Schmitt-Gräff, Ralph Wäsch, Stefanie Hieke, and Martina Kleber
- Subjects
Male ,Bendamustine ,medicine.medical_specialty ,Lymphoma, B-Cell ,Frail Elderly ,Antibodies, Monoclonal, Murine-Derived ,International Prognostic Index ,hemic and lymphatic diseases ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Bendamustine Hydrochloride ,Humans ,Neoplasm Invasiveness ,Progression-free survival ,Aged ,Aged, 80 and over ,business.industry ,Drug Tolerance ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Comorbidity ,Confidence interval ,Surgery ,Lymphoma ,Survival Rate ,Treatment Outcome ,Nitrogen Mustard Compounds ,Cohort ,Female ,Rituximab ,business ,Follow-Up Studies ,medicine.drug - Abstract
We analyzed the safety and efficacy of rituximab plus bendamustine (R-B) in elderly and frail patients with aggressive B-non-Hodgkin lymphoma (a-B-NHL). Few reports have as yet reported on R-B in a-B-NHL, albeit its value for indolent lymphoma vs. R-CHOP has impressively been shown. We assessed 20 consecutive patients with a-B-NHL receiving R-B as first-line or relapse treatment after (R)-CHOP in our department. Besides patient- and lymphoma-specific characteristics, comorbidity indices were determined. The median patient age was 72 years (51-86), the median Karnofsky performance status was 55 % (40-90 %), and according to the international prognostic index, 15 had high-intermediate or high-risk disease. The comorbidity indices revealed a median Kaplan-Feinstein index of 3 (range 1-3), Charlson comorbidity index of 4 (range 0-9), hematopoietic cell transplantation-specific comorbidity index of 3 (range 0-11), and Freiburg comorbidity index of 2 (range 0-2). Moreover, eight patients had echocardiographic and laboratory signs of cardiac insufficiency, all leading to R-B rather than R-CHOP treatment. The overall response rate was 55 %, with complete response and partial response rates of 20 and 35 %, respectively. In our frail and elderly patient cohort, R-B therapy was well-tolerated. Median progression free survival and overall survival were 8.3 months (95 % confidence interval [CI], 2.8--not reached [n.r.]) and 19.4 months (95 % CI, 4.6--n.r.), respectively. We conclude that R-B is a feasible and safe therapy option in a-B-NHL patients not qualifying for R-CHOP but needs to be further assessed in larger subsequent trials, these currently being under way.
- Published
- 2012