Efficacy of CHOP chemotherapy on unspecified peripheral T cell lymphoma in patients aged 80 years and over and its prognostic analysis

Abstract

Objective To evaluate the efficacy of CHOP(cyclophosphamide, doxorubicin, vincristine, and prednisone)chemotherapy on peripheral T cell lymphomas-unspecified(PTCL-U)in patients aged 80 years and over, and investigate the chemotherapy adverse effects and its prognostic factors. Methods Clinical data of 57 patients with PTCL-U confirmed by pathology and immunohistochemistry in Guangzhou First People's Hospital from January 2008 to January 2015 were retrospectively analyzed. The efficacy and adverse effects of CHOP chemotherapy, and its prognostic factors were evaluated. Results Of 57 patients, 11(19.3%)achieved complete remission, 23(40.4%)had partial remission, 14(24.6%)had stable disease, and 9(15.8%)had progressive disease after CHOP chemotherapy, with a total effective rate of 59.6%(34 cases). The expected 1-year, 2-year and 3-year overall survival(OS)rate was 70.2%(40 cases), 36.8%(21 cases) and 17.5%(10 cases), respectively. The median survival time was 18.2 months. Among the 57 patients, 40(70.2%)had hypoplasia of bone marrow at degreeⅠ-Ⅱ, 17(29.8%)at degree Ⅲ-Ⅳ, 49(86.0%)had mild nausea and vomiting(degreeⅠ-Ⅱ), 8(14.0%)had severe nausea and vomiting(degree Ⅲ-Ⅳ), 7 had liver dysfunction, 2 had cardiac toxicity and 7 had disturbance of blood coagulation. Univariate analysis showed that the alkaline phosphatase, Ki-67 percentage, lymphoma international prognostic index(IPI)score, extranodal involved sites(>1), as well as the efficacy and course of chemotherapy were the prognostic factors for survival time in very elderly patients. Multivariate analysis indicated that IPI score>2(95%CI: 1.12~6.35, χ2=5.45, P 1)(95%CI: 2.58-15.32, χ2=16.42, P 4)(5%CI: 0.18~0.79, χ2=7.28, P<0.01)were the independent prognostic factors for the median survival time in very elderly patients. Conclusions PTCL-U patients aged 80 years and over have poor prognosis. CHOP chemotherapy has a certain effect on PTCL-U in very elderly patients, and chemotherapy side effects can be tolerated. IPI score>2 and extranodal involved sites(>1)are the important prognostic factors in very elderly PTCL-U patients. The completion of full course of chemotherapy with remission occurrence is important to prolong survival time in very elderly PTCL-U patients. Key words: Lymphoma, T-cell, Peripheral; Antineoplastic combined chemotherapy protocols; Elderly, aged over 80 years; Prognosis