Davis Christine C, Cohen Jonathon B, Shah Katherine S, Hutcherson Don A, Surati Minal J, Valla Kelly, Panjic Elyse H, Handler Caitlin E, Switchenko Jeffrey M, Flowers Christopher R
Emory University Healthcare and Winship Cancer Institute, Atlanta, GA.
Emory University Healthcare and Winship Cancer Institute, Atlanta, GA.
Clin Lymphoma Myeloma Leuk. 2015 May;15(5):270-7. doi: 10.1016/j.clml.2014.12.011. Epub 2014 Dec 31.
Although diffuse large B-cell lymphoma (DLBCL) can be cured with rituximab and anthracycline-based therapy, within the elderly population there are additional factors to consider in selecting a treatment regimen including comorbid conditions, decreased drug metabolism, decreased hematologic reserve, reduced performance status, and regimen-related toxicity.
We performed a retrospective cohort analysis of patients with DLBCL aged ≥ 65 years at time of diagnosis treated with either an anthracycline-containing regimen (ACR; n = 59) or a non-ACR (n = 13) to assess factors that led to treatment selection, tolerability, and outcomes.
The mean age was 73 years in the ACR and 77 years in the non-ACR group (P = .009), and median left ventricular ejection fraction (LVEF) at diagnosis was 60% in the ACR group and 45% in the non-ACR group (P < .001). With an ACR, elderly DLBCL patients had a median overall survival of 28 months and a 2-year progression-free survival (PFS) of 64%. After an ACR, 14 patients [24%] (out of 59 total patients) had a decrease in LVEF, 7 patients [15%] (% is based off of those who we had the data collected, so this is out of 45 with this specific data) required a dose reduction of the anthracycline, and 15 patients [33%] (% is based off of those who we had the data collected, so this is out of 45 with this specific data) could not complete the regimen as planned. Hospitalization due to toxicity occurred in 20 patients [44%] (% is based off of those who we had the data collected, so this is out of 45 with data) of patients in the ACR group and 3 patients [75%] (% is based off of those who we had the data collected, so this is out of 4 with this specific data) in the non-ACR group, and was the only predictor of overall survival.
Results of this study suggest that elderly patients with DLBCL experience meaningful PFS with ACRs, but a third experience toxicity requiring therapy modification. Future studies should examine larger patient populations and define treatments with outcomes similar to ACR that also decrease toxicity and hospitalization in the elderly DLBCL population.
尽管弥漫性大B细胞淋巴瘤（DLBCL）可通过利妥昔单抗和基于蒽环类药物的疗法治愈，但在老年人群中，选择治疗方案时还需考虑其他因素，包括合并症、药物代谢降低、血液学储备减少、体能状态下降以及与治疗方案相关的毒性。
我们对诊断时年龄≥65岁的DLBCL患者进行了一项回顾性队列分析，这些患者接受了含蒽环类药物方案（ACR；n = 59）或非ACR方案（n = 13）治疗，以评估导致治疗方案选择、耐受性和结局的因素。
ACR组的平均年龄为73岁，非ACR组为77岁（P = 0.009），诊断时左心室射血分数（LVEF）的中位数在ACR组为60%，在非ACR组为45%（P < 0.001）。采用ACR方案时，老年DLBCL患者的总生存期中位数为28个月，2年无进展生存期（PFS）为64%。采用ACR方案后，14例患者（共59例患者中的24%）的LVEF下降，7例患者（15%，百分比基于收集到数据的患者，即45例有该特定数据的患者中的15%）需要减少蒽环类药物剂量，15例患者（33%，百分比基于收集到数据的患者，即45例有该特定数据的患者中的33%）无法按计划完成治疗方案。ACR组有20例患者（44%，百分比基于收集到数据的患者，即45例有数据的患者中的44%）因毒性住院，非ACR组有3例患者（75%，百分比基于收集到数据的患者，即4例有该特定数据的患者中的75%）因毒性住院，且毒性是总生存期的唯一预测因素。
本研究结果表明，老年DLBCL患者采用ACR方案可获得有意义的PFS，但三分之一的患者会出现需要调整治疗的毒性反应。未来的研究应考察更大规模的患者群体，并确定在老年DLBCL患者中疗效与ACR相似且能降低毒性和住院率的治疗方法。
