Skip to main content
SpringerLink
Log in

Clinical characteristics, treatment patterns and outcomes of patients older than 80 years diagnosed with DLBCL in China over a 10-year period

  • Original Article
  • Published:
Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The treatment strategy for elderly patients older than 80 years with DLBCL has not been defined yet because of poor treatment tolerability and lack of data. The aim of this trial was to retrospectively investigate clinical characteristics, treatment patterns and outcomes of patients older than 80 years diagnosed with DLBCL in China over a 10-year period.

Methods

This trial comprised 57 patients, aged ≥ 80 years, who were initial diagnosed as diffuse large B-cell lymphoma from 2007 to 2017. They received at least four cycles of reduced-dose R-CHOP21 (Rituximab 375 mg/m2 day 0, Cyclophosphamide 400 mg/m2 day1, Epirubicin 35 mg/m2 day 1, Vincristine 1 mg day 1, and Prednisone 50 mg/m2 days 1–5). An observational population-based, cohort study was performed.

Results

The median age was 82.5 years (range 80–90 years ) and the overall response rate was 73.7%. With a median 36.4-month follow-up, 2-year overall survival (OS) and 2-year progression-free survival were 74.3% and 70.9%, respectively. Using rigorous multivariate analysis, we concluded that NCCN-IPI ≥ 5 was the only predictive poor prognostic factor.

Conclusions

High response rate was concluded on very elderly DLBCL patients (≥ 80 years old) with reduced-dose R-CHOP. However, the very elderly patients with NCCN-IPI score ≥ 5 would lead to poor outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Yancik R, Ries LA (2004) Cancer in older persons: an international issue in an aging world. Semin Oncol 31:128–136. https://doi.org/10.1053/j.seminoncol.2003.12.024

    Article  PubMed  Google Scholar 

  2. Coiffier B, Thieblemont C, Van Den Neste E, Lepeu G, Plantier I, Castaigne S et al (2010) Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Grouped’Etudes des Lymphomes de l’Adulte. Blood 116:2040–2045. https://doi.org/10.1182/blood-2010-03-276246

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Harris NL, Jaffe ES, Diebold J et al (1999) World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 17:3835–3849. https://doi.org/10.1200/JCO.1999.17.12.3835

    Article  CAS  PubMed  Google Scholar 

  4. Reuben DB et al (1997) Correlates of hypoalbuminemia in community-dwelling older persons. Am J Clin Nutr 66:38–45. https://doi.org/10.1093/ajcn/66.1.38

    Article  CAS  PubMed  Google Scholar 

  5. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project (1993) A predictive model for aggressive non-Hodkin’s lymphoma. N Engl J Med 329:987–994. https://doi.org/10.1056/NEJM199309303291402

    Article  Google Scholar 

  6. Advani RH, Chen H, Habermann TM et al (2010) Comparison of conventional prognostic indices in patients older than 60 years with diffuse large B-cell lymphoma treated with R-CHOP in the US Intergroup Study (ECOG 4494, CALGB 9793): consideration of age greater than 70 years in an elderly prognostic index (E-IPI). Br J Haematol 151:143–151. https://doi.org/10.1111/j.1365-2141.2010.08331.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Prochazka V, Pytlik R, Janikova A et al (2014) A new prognostic score for elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: the prognostic role of blood monocyte and lymphocyte counts is absent. PLoS ONE 9:e102594. https://doi.org/10.1371/journal.pone.0102594

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Zhou Z, Sehn LH, Rademaker AW et al (2014) An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood 123:837–842. https://doi.org/10.1182/blood-2014-06-583476

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ziepert M, Schmits R, Trumper L et al (2008) Prognostic factors for hematotoxicity of chemotherapy in aggressive non-Hodgkin’s lymphoma. Ann Oncol 19:752–762. https://doi.org/10.1093/annonc/mdm541

    Article  CAS  PubMed  Google Scholar 

  10. Johnson NA, Slack GW, Savage KJ et al (2012) Concurrent expression of MYC and BCL2 in diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Clin Oncol 30:3452–3459. https://doi.org/10.1002/cncr.27396

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V et al (2008) A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc 56:1926–1931. https://doi.org/10.1111/j.1532-5415.2008.01935.x

    Article  PubMed  Google Scholar 

  12. Eyre TA, Salisbury R, Eyre DW et al (2016) Results of a large retrospective analysis of the effect of intended dose intensity of R-CHOP on outcome in a cohort of consecutive, unselected elderly patients with de novo diffuse large B cell lymphoma. Br J Haematol 173:487–491. https://doi.org/10.1111/bjh.13619

    Article  PubMed  Google Scholar 

  13. Carson KR, Riedell P, Lynch R et al (2015) Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma. J Geriatr Oncol 6:211–218. https://doi.org/10.1016/j.jgo.2015.01.003

    Article  PubMed  PubMed Central  Google Scholar 

  14. Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M et al (2015) Approach to therapy of diffuse large B-cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary. Ann Oncol 26:1058–1068. https://doi.org/10.1093/annonc/mdv018

    Article  CAS  PubMed  Google Scholar 

  15. Hainsworth JD, Flinn IW, Spigel DR, Clark BL, Griner PL, Vazquez ER et al (2010) Brief-duration rituximab/chemotherapy followed by maintenance rituximab in patients with diffuse large B-cell lymphoma who are poor candidates for R-CHOP chemotherapy: a phase II trial of the Sarah Cannon Oncology Research Consortium. Clin Lymphoma Myeloma Leuk 10:44–50. https://doi.org/10.3816/CLML.2010.n.004

    Article  CAS  PubMed  Google Scholar 

  16. Meguro A et al (2012) Rituximab plus 70% cyclophosphamide, doxorubicin, vincristine and prednisone for Japanese patients with diffuse large B-cell lymphoma aged 70 years and older. Leuk Lymphoma 53:43–49. https://doi.org/10.3109/10428194.2011.600486

    Article  CAS  PubMed  Google Scholar 

  17. Weidmann E, Neumann A, Fauth F, Atmaca A, Al-Batran SE, Pauligk C et al (2011) Phase II study of bendamustine in combination with rituximab as first-line treatment in patients 80 years or older with aggressive B-cell lymphomas. Ann Oncol 22:1839–1844. https://doi.org/10.1093/annonc/mdq671

    Article  CAS  PubMed  Google Scholar 

  18. Fields PA, Townsend W, Webb A et al (2014) De novo treatment of diffuse large B-cell lymphoma with rituximab, cyclophosphamide, vincristine, gemcitabine, and prednisolone in patients with cardiac comorbidity: a United Kingdom National Cancer Research Institute trial. J Clin Oncol 32:282–287. https://doi.org/10.1200/JCO.2013.49.7586

    Article  CAS  PubMed  Google Scholar 

  19. Peyrade F, Jardin F, Thieblemont C, Thyss A, Emile JF, Castaigne S et al (2011) Attenuated immunochemotherapy regimen (R-miniCHOP) in elderly patients older than 80 years with diffuse large B-cell lymphoma: a multicentre, single-arm, phase 2 trial. Lancet Oncol 12:460–468. https://doi.org/10.1016/S1470-2045(11)70069-9

    Article  CAS  PubMed  Google Scholar 

  20. Musolino A, Boggiani D, Panebianco M, Vasini G, Salvagni S, Franciosi V et al (2011) Activity and safety of dose-adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor-prognostic untreated diffuse large B-cell non-Hodgkin lymphoma. Cancer 117:964–973. https://doi.org/10.1002/cncr.25582

    Article  CAS  PubMed  Google Scholar 

  21. Osby E, Hagberg H, Kvaloy S, Teerenhovi L, Anderson H, Cavallin-Stahl E et al (2003) CHOP is superior to CNOP in elderly patients with aggressive lymphoma while outcome is unaffected by filgrastim treatment: results of a Nordic Lymphoma Group randomized trial. Blood 101:3840–3848. https://doi.org/10.1182/blood-2002-10-3238

    Article  CAS  PubMed  Google Scholar 

  22. Bessell EM, Burton A, Haynes AP, Glaholm J, Child JA, Cullen MH et al (2003) A randomized multicentre trial of modifed CHOP versus MCOP in patients aged 65 years and over with aggressive non-Hodgkin’s lymphoma. Ann Oncol 14:258–267. https://doi.org/10.1093/annonc/mdg067

    Article  CAS  PubMed  Google Scholar 

  23. Hryniuk WM, Goodyear M (1990) The calculation of received dose intensity. J Clin Oncol 8:1935–1937. https://doi.org/10.1200/JCO.1990.8.12.1935

    Article  CAS  PubMed  Google Scholar 

  24. Cheson BD, Pfistner B, Juweid ME et al (2007) Revised response criteria for malignant lymphoma. J Clin Oncol 25:579–586. https://doi.org/10.1200/JCO.2006.09.2403

    Article  PubMed  Google Scholar 

  25. Lyman GH, Dale DC, Friedberg J et al (2004) Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin’s lymphoma: a nationwide study. J Clin Oncol 22:4302–4311. https://doi.org/10.1200/JCO.2004.03.213

    Article  CAS  PubMed  Google Scholar 

  26. Dixon DO, Neilan B, Jones SE et al (1986) Effect of age on therapeutic outcome in advanced diffuse histiocytic lymphoma: the Southwest Oncology Group experience. J Clin Oncol 4:295–305. https://doi.org/10.1200/JCO.1986.4.3.295

    Article  CAS  PubMed  Google Scholar 

  27. Balducci L, Repetto L (2004) Increased risk of myelotoxicity in elderly patients with non-Hodkgin lymphoma. Cancer 100:6–11. https://doi.org/10.1002/cncr.11861

    Article  PubMed  Google Scholar 

  28. Trotti A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13:176–181. https://doi.org/10.1016/S1053-4296(03)00031-6

    Article  PubMed  Google Scholar 

  29. Lichtman SM (2004) Chemotherapy in the elderly. Semin Oncol 31:160–174. https://doi.org/10.1053/j.seminoncol.2003.12.027

    Article  CAS  PubMed  Google Scholar 

  30. Choi JH et al (2018) Multicenter retrospective analysis of clinical characteristics, treatment patterns, and outcomes in very elderly patients with diffuse large B-cell lymphoma: the Korean Cancer Study Group LY16-01. Cancer Res Treat 50:590–598. https://doi.org/10.4143/crt.2017.172

    Article  CAS  PubMed  Google Scholar 

  31. Delarue R, Tilly H, Mounier N, Salles G, Thieblemont C, Bologna S et al (2013) Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. Lancet Oncol 14:525–533. https://doi.org/10.1016/S1470-2045(13)70122-0

    Article  CAS  PubMed  Google Scholar 

  32. Doorduijn JK, van der Holt B, van Imhoff GW et al (2003) CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin’s lymphoma. J Clin Oncol 21:3041–3050. https://doi.org/10.1200/JCO.2003.01.076

    Article  CAS  PubMed  Google Scholar 

  33. Pfreundschuh M, Schubert J, Ziepert M, Schmits R, Mohren M, Lengfelder et al (2008) Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20 + B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 9:105–116. https://doi.org/10.1016/S1470-2045(08)70002-0

    Article  CAS  PubMed  Google Scholar 

  34. Peters FP, Lalisang RI, Fickers MM et al (2001) Treatment of elderly patients with intermediate- and high-grade non-Hodgkin’s lymphoma: a retrospective population-based study. Ann Hematol 80:155–159. https://doi.org/10.1007/s002770000255

    Article  CAS  PubMed  Google Scholar 

  35. Pfreundschuh M (2010) How I treat elderly patients with diffuse large B-cell lymphoma. Blood 116:5103–5110. https://doi.org/10.1182/blood-2010-07-259333

    Article  CAS  PubMed  Google Scholar 

  36. Trebouet A, Marchand T, Lemal R et al (2013) Lymphoma occurring in patients over 90 years of age: characteristics, outcomes, and prognostic factors: a retrospective analysis of 234 cases from the LYSA. Ann Oncol 24:2612–2618. https://doi.org/10.1093/annonc/mdt282

    Article  CAS  PubMed  Google Scholar 

  37. Peyrade F, Bologna S, Delwail V et al (2017) Combination of ofatumumab and reduced-dose CHOP for diffuse large B-cell lymphomas in patients aged 80 years or older: an open-label, multicentre, single-arm, phase 2 trial from the LYSA group. Lancet Haematol 4:e46–e55. https://doi.org/10.1016/S2352-3026(16)30171-5

    Article  PubMed  Google Scholar 

  38. Shi Z, Tang X, Wang J et al (2016) Rituximab plus reduced-dose cyclophosphamide, doxorubicin, vincristine and prednisone (RD R-CHOP) chemotherapy is feasible for very elderly patients (≥ 80 years) with B-cell lymphoma: analysis of treatment outcome. J Chemother 28:487–493. https://doi.org/10.1080/1120009X.2016.1196869

    Article  CAS  PubMed  Google Scholar 

  39. Mora O, Zucca E (2007) Management of elderly patients with hematological neoplasms. Ann Oncol 18(Suppl 1):i49–i53. https://doi.org/10.1093/annonc/mdl451

    Article  PubMed  Google Scholar 

  40. Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V et al (2008) A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc 56:1926–1931. https://doi.org/10.1111/j.1532-5415.2008.01935.x

    Article  PubMed  Google Scholar 

  41. Wedding U, Roehrig B, Klippstein A, Steiner P, Schaeffer T, Pientka L et al (2007) Comorbidity in patients with cancer: prevalence and severity measured by cumulative illness rating scale. Crit Rev Oncol Hematol 61:269–276. https://doi.org/10.1016/j.critrevonc.2006.11.001

    Article  PubMed  Google Scholar 

  42. Soubeyran P, Fonck M, Blanc-Bisson C et al (2012) Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol 30:1829–1834. https://doi.org/10.1200/JCO.2011.35.7442

    Article  PubMed  Google Scholar 

  43. Jung YH, Woo IS, Han CW (2015) Clinical characteristics and outcomes in diffuse large B cell lymphoma patients aged 70 years and older: a single-center experience with a literature review. Korean J Intern Med 30:684–693. https://doi.org/10.3904/kjim.2015.30.5.684

    Article  PubMed  PubMed Central  Google Scholar 

  44. Miura K, Kobayashi Y, Hojo A et al (2011) Attenuated immunochemotherapy for diffuse large B-cell lymphoma. Lancet Oncol 12:725–726. https://doi.org/10.1016/S1470-2045(11)70152-8

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We want to express great thanks for guidance of the editorial assistance from Prof. Bao zhijun, the director of the department of science and education of Shanghai Hua’Dong Hospital, PRC.

Funding

Shanghai Key Laboratory of Clinical Geriatric Medicine (No. 13DZ2260700). Research Center on Aging and Medicine, Fudan University and Shanghai Key Developing Disciplines Program (No. 2015ZB0501).

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Hua’Dong Hospital Affiliated to Fudan University, Shanghai, 200040, China

    Zhan Shi, Xi Tang, Jiayan Chen, Fei Liu, Xi Chen, Jingwen Wang & Jie Zhuang

  2. Department of Radiation Oncology, Hua’Dong Hospital Affiliated to Fudan University, Room 403, 6th Building, No. 221, Yan’an West Road, Shanghai, 200040, China

    Qianwen Shen

Authors
  1. Zhan Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xi Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qianwen Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiayan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jingwen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jie Zhuang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xi Tang.

Ethics declarations

Conflicts of interest

There is no conflict of interest by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, Z., Tang, X., Shen, Q. et al. Clinical characteristics, treatment patterns and outcomes of patients older than 80 years diagnosed with DLBCL in China over a 10-year period. Cancer Chemother Pharmacol 84, 127–137 (2019). https://doi.org/10.1007/s00280-019-03859-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00280-019-03859-6

Keywords

Search

Navigation