Reply to age-related differences in quality of life among patients with diffuse large B-cell lymphoma.

Abstract

We appreciate the thoughtful correspondence from Oerlemans et al in regard to our article.1 Although patients aged >80 years have the highest incidence of diffuse large B-cell lymphoma (DLBCL), this population is rarely included in studies. Thus, we sought to characterize current treatment and survival patterns for patients aged >80 years (1156 patients) to determine the most effective management strategies for this population. To our knowledge, our study is the largest yet to examine DLBCL treatment and survival outcomes in patients aged >80 years. We found that in patients with DLBCL who are aged >80 years, the combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was associated with the longest survival, even after controlling for potential confounders such as performance status and comorbidity. Although our data suggested that age alone should not be used as a contraindication to effective treatment, there are a multitude of other factors that influence DLBCL treatment selection and survival.2 Quality of life (QOL) is one such important consideration for elderly patients with cancer. In their letter, Oerlemans et al presented findings from their recent studies examining QOL in elderly patients with DLBCL. They found that those who received R-CHOP every 2 weeks had decreased health-related QOL (HRQOL) compared with patients who received R-CHOP every 3 weeks.3 In another study, they found that although cancer and its treatment affect HRQOL in patients with DLBCL, this effect appears to be less significant for patients aged 76 to 85 years.4 This finding was believed to be due to less aggressive treatment and enhanced coping skills in elderly patients. Taken together, these results emphasize that QOL should be incorporated into treatment decision-making for elderly patients with DLBCL at both the individual level (incorporating patient preferences) and the population level (to establish strategies for R-CHOP administration in this population). In addition, treatment toxicity is a factor that may affect HRQOL in elderly patients with DLBCL. A recent study found that approximately one-third of elderly patients with DLBCL who received anthracycline-based therapy experienced toxicity requiring treatment modification.5 These results suggest that elderly patients are more susceptible to anthracycline toxicity and that optimal dosing should be investigated further in this population. In conclusion, we agree with the points raised by Oerlemans et al and advocate for further studies examining the effect of DLBCL treatment on QOL and toxicity in elderly patients. This work was supported by National Institutes of Health grant R21CA158686. Dr. Flowers is supported by National Institutes of Health grant R21CA158686 for work performed as part of the current study. He has acted as a paid consultant for Spectrum, Celgene, OptumRx, and Seattle Genetics and as an unpaid consultant for Genentech, Biogen Idec, Roche, and Millennium/Takeda. He has received research funding from AbbVie, Acerta, Celgene, Gilead Sciences, Infinity Pharmaceuticals, Janssen Pharmaceuticals, Millennium/Takeda, Spectrum, Onyx Pharmaceuticals, and Pharmacyclics as well as payment for the development of educational presentations from Clinical Care Options, Educational Concepts, and Research to Practice. Jessica N. Williams, BS Emory University School of Medicine Atlanta, Georgia Ashish Rai, MBBS, MSPH Department of Health Policy and Management Rollins School of Public Health Emory University Atlanta, Georgia Christopher R. Flowers, MD, MS Department of Hematology and Oncology Winship Cancer Institute Emory University Atlanta, Georgia