engleski

OUTCOME OF OLDER PATIENTS WITH B-LARGE CELL LYMPHOMA (B-LCL)-AN OBSERVATIONAL STUDY OF KROHEM, THE CROATIAN COOPERATIVE GROUP FOR HEMATOLOGICAL DISEASES

Background: Approximately half of the patients with diffuse large B-cell lymphoma (DLBCL) are older than 60 years and their outcome is inferior in comparison to younger patients. Aims: We aimed to assess the impact of age, risk factors and the type of treatment on event-free survival (EFS) and overall survival (OS). Methods: In this retrospective study, 304 patients with DLBCL older than 60 years or equal were included. A total of 218 patients were included in an observational study of patients treated with rituximab conducted at 15 general and university hospitals in 2007 and 2008. Additional patients were recruited from two clinical centers. Results: The median age was 73 years (range 60- 90), 144 were men and 160 women. 205 patients were treated with R-CHOP, 27 with R-CVP, 24 with RCNOP (mitoxantrone instead of doxorubicin), 20 with R- DA-EPOCH, 9 with RCEOP (etoposide instead of doxorubicin), and 19 patients received other regimens or no chemotherapy. After a median follow up of 52 months for survivors, the estimated 5- year EFS and 5-year OS were 43% and 47%, respectively. Half of the patients are alive at the time of last follow up. Lymphoma, infections, and cardiac events were the leading causes of death. A total of 52% patients died during first- line treatment, 24% died in remission, and 24% died in relapse. There were 16 secondary malignancies reported. The aaIPI significantly correlated with EFS (p=0.002) and OS (p=0.001). Gender, bulky disease (>5cm), and extranodal involvement were not associated with survival, whereas B symptoms were significantly predictive of EFS (p=0.002) and OS (p<0.001). Age had a negative impact on survival: patients between 60 and 65 years fared well (5- year OS 65%), patients from 66 to 75 years of age worse (5-year OS 46%), and those older than 75 years the worst (5-year OS 38%) ; p=0.004 (Figure 1A). Treatment choice also influenced EFS and OS: R-CVP and R-CNOP had worst outcomes worst, whereas those of R-CEOP and R-DA- EPOCH were at least comparable to R-CHOP ; p=0.025 for EFS, p=0.009 for OS (Figure 1B). Summary/Conclusions: R-CHOP remains the standard of care in elderly patients with B-LCL. The aaIPI and presence of B symptoms influence prognosis. Survival decreases with age ; cut-offs at 65 and 75 years are discriminative. R-CNOP has only modest efficacy, similar to R-CVP. Etoposide may serve as an alternative to anthracyclines for patients with cardiac comorbidities, and R-DA-EPOCH may represent a good option for high-risk patients.

Diffuse Large Cell Lymphoma ;

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