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Abstract
In 2003 the Fondazione Italiana Linfomi (FIL) started a clinical research program for investigating initial treatment of frail elderly patients with diffuse large B-cell lymphoma (DLBCL) identified by Comprehensive Geriatric Assessment (CGA). From 2003 to 2006, 334 elderly patients underwent CGA assessment, and 99 patients were classified as frail. Frail patients had a median age of 78 years, stage III–IV disease in 62% and age-adjusted International Prognostic Index (aaIPI) of 2–3 in 53%. Treatment consisted of several different regimens according to physician discretion. After a median follow-up of 36 months, 5-year overall survival (OS) was 28%. In multivariate analysis, aaIPI 2–3 (p = 0.005) and the presence of respiratory comorbidity (p = 0.044) were the only factors that showed independent correlation with OS. Frail patients had a poorer outcome compared with fit patients also if they were treated with rituximab-containing combination chemotherapy (hazard ratio 2.37, 95% confidence interval 1.48–3.78; p < 0.001). CGA is a valid tool to prospectively identify frail subjects among elderly patients with DLBCL.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of non-Hodgkin lymphoma (NHL) and frequently affects elderly people [1]
Patients were excluded if affected by a concomitant cancer other than lymphoma, another cancer diagnosed within 5 years before the lymphoma diagnosis, or if they were positive for human immunodeficiency virus (HIV)
From 2003 to 2006, 334 elderly patients with DLBCL were prospectively registered in the study and underwent Comprehensive Geriatric Assessment (CGA) assessment; seven patients were not included due to lack of data, 228 were considered fit and 224 of these were fully eligible for the randomized trial
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of non-Hodgkin lymphoma (NHL) and frequently affects elderly people [1]. With the use of immunochemotherapy, elderly fit patients can be safely treated with a 50–60% chance of cure and with manageable toxicity [2,3,4]. In contrast to fit patients, the chance of cure for frail patients with DLBCL is poor [5,6]. This is a result of the negative effect of concomitant diseases on patients’ outcome or treatment morbidity and the lack of standard therapies. Most frail patients are frequently treated with modified versions of standard regimens, reducing doses of drugs, or using less toxic drugs [7,8,9]
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