Lee Keun-Wook, Kim Dae-Young, Yun Tak, Kim Dong-Wan, Kim Tae-You, Yoon Sung-Soo, Heo Dae Seog, Bang Yung-Jue, Park Seonyang, Kim Byoung Kook, Kim Noe Kyeong
Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Cancer. 2003 Dec 15;98(12):2651-6. doi: 10.1002/cncr.11846.
Although many studies of elderly patients with non-Hodgkin lymphoma have focused on the dose intensity of chemotherapy, few studies have restricted the histologic inclusion criteria such that only patients with diffuse large B-cell lymphoma (DLCL) are considered. In the current study, treatment outcomes for elderly patients (age > or = 60 years) were analyzed, with emphasis on the dose intensity of doxorubicin.
Between 1994 and 2000, 195 patients with DLCL were treated initially with doxorubicin-based chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone; or cyclophosphamide, vincristine, bleomycin, doxorubicin, procarbazine, and prednisone). Of these patients, 70 were aged 60 years or older.
Elderly patients had poorer treatment outcomes than did young patients (5-year survival, 30% vs. 57%; P < 0.001); however, elderly patients who received doxorubicin at dose intensities > or = 10 mg/m2 per week (n = 25) had outcomes (5-year survival, 52%) that were comparable to those of young patients. Among prognostic factors, only International Prognostic Index score (P = 0.022) and dose intensity of doxorubicin (P = 0.039) were found to have significant effects on the overall survival of elderly patients. When the reasons for doxorubicin dose reduction in 45 elderly patients who ultimately received doxorubicin at dose intensities < 10 mg/m2 per week were analyzed, it was found that 20 patients received reduced doses from the start of treatment because of their old age alone; these dose reductions in the 20 cases resulted in poorer treatment outcomes.
Elderly patients with DLCL who received doxorubicin at dose intensities > or = 10 mg/m2 per week had treatment outcomes that were comparable to those of young patients; however, physician bias associated with patient age was found to be related to unnecessary dose reductions. Efforts to maintain doxorubicin dose intensities > or = 10 mg/m2 per week and more objective standards for the selection of elderly patients capable of tolerating doxorubicin-based regimens are required.
尽管许多针对老年非霍奇金淋巴瘤患者的研究都聚焦于化疗的剂量强度，但很少有研究限制组织学纳入标准，以至于仅考虑弥漫性大B细胞淋巴瘤（DLCL）患者。在本研究中，分析了老年患者（年龄≥60岁）的治疗结果，重点关注阿霉素的剂量强度。
1994年至2000年间，195例DLCL患者最初接受了以阿霉素为基础的化疗（环磷酰胺、阿霉素、长春新碱和泼尼松；或环磷酰胺、长春新碱、博来霉素、阿霉素、丙卡巴肼和泼尼松）。其中，70例患者年龄在60岁及以上。
老年患者的治疗结果比年轻患者差（5年生存率，30%对57%；P<0.001）；然而，每周接受阿霉素剂量强度≥10mg/m²的老年患者（n=25）的治疗结果（5年生存率，52%）与年轻患者相当。在预后因素中，仅国际预后指数评分（P=0.022）和阿霉素剂量强度（P=0.039）对老年患者的总生存有显著影响。分析最终接受阿霉素剂量强度<10mg/m²每周的45例老年患者中阿霉素剂量降低的原因时发现，20例患者仅因年龄大从治疗开始就接受了剂量降低；这20例患者的剂量降低导致治疗结果较差。
每周接受阿霉素剂量强度≥10mg/m²的老年DLCL患者的治疗结果与年轻患者相当；然而，发现与患者年龄相关的医生偏见与不必要的剂量降低有关。需要努力维持阿霉素剂量强度≥10mg/m²每周，并制定更客观的标准来选择能够耐受以阿霉素为基础方案的老年患者。
