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

Abstract

Musolino et al reported their experience with a reduced dose regimen designed for “very elderly” patients with high-risk diffuse large B-cell non-Hodgkin lymphomas.1 They treated 23 patients (median age, 77 years), most of whom were diagnosed with an advanced stage of disease and poor prognostic score, with 6 to 8 courses of dose-adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab (DA-POCH-R). This regimen is an anthracycline-based scheme whose dose intensity, compared with the CHOP regimen, is 88% for doxorubicin, 53% for cyclophosphamide, and nearly 90% for vincristine; however, 12 cycles in 9 patients were administered at reduced doses. The overall response rate was 90%, with a complete response rate of 57%; the 3-year overall survival and event-free survival rates were 56% and 54%, respectively. Hematological toxicity was manageable and nonhematological toxicity was negligible. The authors concluded that this regimen was a reasonable alternative for elderly patients who were not considered to be able to tolerate standard treatment with R-CHOP. Although we believe the study is interesting, the authors did not make specific mention of the criteria used for the recruitment of patients and, in particular, they did not mention the comprehensive geriatric assessment (CGA), based on cumulative comorbidities and the ability to perform basic and instrumental daily life activities.2, 5 In our clinical practice, we treat elderly “fit” patients with R-CHOP, and the majority of “unfit” or “frail” patients are treated with the R-VV regimen, which is comprised of rituximab plus oral vinorelbine and etoposide, and which permits appreciable results with acceptable toxicity and the avoidance of hospital admission. In conclusion, we believe that a broader application of CGA could lead to a better selection of patients and, consequently, studies with more comparable results. Alberto Fabbri MD*, Alessandro Gozzetti MD*, Luigi Rigacci MD , * Department of Hematology, University Hospital of Siena, Siena, Italy, Department of Hematology, University Hospital of Florence, Florence, Italy.