Abstract
BackgroundRituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is broadly accepted as standard for the treatment of diffuse large B-cell lymphoma (DLBCL). Nevertheless, there is sparsely data concerning the management of elderly patients.MethodsWe performed a retrospective study of treatment with rituximab and low-dose trofosfamide in elderly patients (≥ 75 years) with DLBCL who were not suitable for R-CHOP or R-CHOP-like regimens or who did not consent to aggressive treatment. The choice regarding the qualification for R-CHOP or R-CHOP-like regimen was left to the estimation of the treating physicians.ResultsEleven patients with a median age of 83 years (range, 75–90 years) were included. The age-adjusted international prognostic index was low risk in one patient, low-intermediate in four patients, high-intermediate in three patients, and high risk in 3 patients. All patients were evaluable for response. Five patients (45%) achieved a complete response, three (27%) a partial response, one (9%) stable disease, and two (18%) progressive disease. The estimated 1-yr overall survival was 54.5%, and the estimated 1-yr progression-free survival 45.5%, however, three patients (27%) were alive without evidence of disease at 16–20 months from start of treatment. Main toxicity was leukopenia (36% grade III or IV), whereas grade III/IV non-hematological adverse events did not occur.ConclusionsDue to its potency and low toxicity, trofosfamide/rituximab might represent an alternative therapy for DLBCL of elderly patients not suitable for R-CHOP. This observation, however, should be confirmed in a larger patient population within a prospective clinical trial.
Highlights
Rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is broadly accepted as standard for the treatment of diffuse large B-cell lymphoma (DLBCL)
In one particular case of relapsing anaplastic large-cell lymphoma trofosfamide treatment resulted in ongoing complete remission 16 months after withdrawal of the drug [31]. Since these findings proved potency of trofosfamide in NHL and as the drug was very well-tolerated yet in older patients [32], compassionate use of low-dose trofosfamide and rituximab (R-T) in elderly patients who were not eligible for standard immunochemotherapy, was conducted
According to International Prognostic Index (IPI), 9% were at low risk, 36% were at low-intermediate risk, 27% at high-intermediate risk and 27% at high risk
Summary
Rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is broadly accepted as standard for the treatment of diffuse large B-cell lymphoma (DLBCL). The current annual incidence of DLBCL is estimated to be 7 cases per 100,000 persons [1]. This incidence continually increases with age, and approximately 40% of cases occur in patients elder than 70 years [2]. Due to the global ascent of the older population, an additional rise of the absolute count. It is not clear if DLBCL in the elderly carries a different genotype than in younger patients but it was demonstrated that molecular features with distinct prognosis are associated with age [7].
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