Comprehensive geriatric assessment (CGA)-adapted chemotherapy (CT) in 100 elderly patients (pts) (>70 years) with diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL)

Abstract

19515 Rituximab+CHOP (R-CHOP) is the standard CT regimen for elderly pts with CD20+ DLBCL. However, many pts ≥70 yrs are often unable to received R-CHOP and are excluded from clinical trials. Moreover, CGA has been demonstrated a useful instrument to predict the clinical outcome of elderly cancer pts even if it has never been tested prospectively. Within the GOL (Onco-hematological Lymphoma Group) from June 2000 to March 2006 we started a phase II prospective study to evaluate the feasibility and activity of a CGA-driven CT for elderly pts with DLBCL. Rituximab was used in all pts after February 2002. Pts with no comorbidity received CHOP or R-CHOP; in pts with mild cardiopathy epirubicin was used instead of doxorubicin (CEOP or R-CEOP); in pts with moderate or severe cardiopathy the use of antracyclines was omitted (CVP or R-CVP). CT dosage was decided according to CGA: pts with a good CGA score (ADL=6, IADL>6) received full doses of CT; pts with an intermediate score (ADL=5, IADL>4) received 75% of the planned dose; pts with a poor score (ADL<5, IADL<5) received 50% dose. All pts received prophylactic filgrastim; 100 pts (41 males and 59 females) have been treated and no pt was excluded from this approach. Median age was 75 yrs (range 70–89) and 51% were stages III-IV. Sixty-one per cent of pts received full doses of CT, 86% received antracycline (doxorubicin in 56% and epirubicin in 30%) and 54% received rituximab plus CT. The following regimens were used: R-CHOP 22%, CHOP 16%, 75%-R-CHOP 10%, 75%-CHOP 8%, CEOP 11%, R-CEOP 4%, 75%-R-CEOP 9%, 75%-CEOP 6%. The remaining pts received CVP in 5% of cases and reduced R-CVP in 9% of cases. The toxicity was quite acceptable, however 4 toxic deaths occurred (2 septic shock, 1 acute respiratory failure and 1 acute myocardial infarction). Overall, 76% achieved CR and with a median follow-up of 24 months (range 1–71 months) only 16% relapsed. Seventy-three pts are alive and 63% in CR. Our results demonstrated that a CGA-driven approach is feasible and highly active in elderly pts with DLBCL. Moreover this strategy allows a potentially curative approach to all pts with aggressive NHL avoiding both to under-treat elderly pts with a curable disease and to over-treat elderly pts with comorbidities. No significant financial relationships to disclose.