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Impact of intended and relative dose intensity of R‐CHOP in a large, consecutive cohort of elderly diffuse large B‐cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age
- Source :
- Journal of Internal Medicine. 285:681-692
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Background The increasing incidence of diffuse large B‐cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co‐morbidity, frailty, and reduced organ and physiological reserve contribute to treatment‐related complications. The optimal dose intensity of R‐CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear. Objectives and Methods We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009–2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. Results Progression‐free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70–79 years (P < 0.001). In contrast, 2‐year cumulative relapse incidence, when accounting for non‐relapse mortality as a competing risk, was no different between 70–79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS‐G: 0–6 vs. >6) (P = 0.27). In 70–79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI 80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32). Conclusion ‘R‐mini‐CHOP' provides adequate lymphoma‐specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.
- Subjects :
- Male
0301 basic medicine
medicine.medical_specialty
Cyclophosphamide
Comorbidity
030204 cardiovascular system & hematology
Cohort Studies
03 medical and health sciences
Age Distribution
0302 clinical medicine
Recurrence
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Internal Medicine
Humans
Medicine
Cumulative incidence
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Proportional hazards model
Incidence
Incidence (epidemiology)
Age Factors
medicine.disease
Lymphoma
Treatment Outcome
030104 developmental biology
Doxorubicin
Vincristine
Cohort
Prednisone
Female
Lymphoma, Large B-Cell, Diffuse
Rituximab
business
Diffuse large B-cell lymphoma
medicine.drug
Subjects
Details
- ISSN :
- 13652796 and 09546820
- Volume :
- 285
- Database :
- OpenAIRE
- Journal :
- Journal of Internal Medicine
- Accession number :
- edsair.doi.dedup.....ff4b5cf19b4aa01b03cab530bc51ded4