Iioka Futoshi, Izumi Kiyotaka, Kamoda Yoshimasa, Akasaka Takashi, Ohno Hitoshi
Department of Hematology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
Int J Clin Oncol. 2016 Jun;21(3):498-505. doi: 10.1007/s10147-015-0912-6. Epub 2015 Oct 13.
Although the number of patients aged 80 years or older with aggressive B-cell non-Hodgkin lymphoma (B-NHL) has increased in the clinical setting, management has been challenging due to lower tolerability. The aim of the present study was to evaluate the efficacy and safety of reduced-dose chemotherapy for very elderly patients.
We retrospectively analyzed the clinical outcomes of patients aged ≥80 years old with diffuse large B-cell lymphoma (n = 58) or grade 3 follicular lymphoma (n = 3).
Patient ages ranged from 80 to 93 years old, with a median of 83 years old. Twenty-four patients were treated with CHOP or THP-COP, the dosages of which were variably reduced, in combination with rituximab (R-vCHOP), while another 24 patients were treated with R-miniCHOP. Twelve R-vCHOP and 16 R-miniCHOP patients completed the chemotherapy cycles. The estimated 2-year progression-free and overall survival rates in the R-vCHOP and R-miniCHOP groups were 53 and 39 % (P = 0.92) and 53 and 48 % (P = 0.95), respectively. Performance status ≥2, lactate dehydrogenase level >normal, serum albumin ≤3.5 g/dL, C-reactive protein ≥2.0 mg/dL, age-adjusted International Prognostic Score 2/3, and withdrawal from the chemotherapy cycle were associated with poor survival. The frequency of chemotherapy-related hospitalization during the second or later cycles was significantly less in the R-miniCHOP group.
The efficacies of R-vCHOP and R-miniCHOP were similar in patients aged ≥80 years old with aggressive B-NHL. The reduced frequency of hospitalization observed for R-miniCHOP treatment is beneficial for very elderly patients.
尽管在临床环境中，80岁及以上侵袭性B细胞非霍奇金淋巴瘤（B-NHL）患者的数量有所增加，但由于耐受性较低，治疗一直具有挑战性。本研究的目的是评估低剂量化疗对高龄患者的疗效和安全性。
我们回顾性分析了年龄≥80岁的弥漫性大B细胞淋巴瘤患者（n = 58）或3级滤泡性淋巴瘤患者（n = 3）的临床结局。
患者年龄在80至93岁之间，中位年龄为83岁。24例患者接受了CHOP或THP-COP治疗，其剂量有所不同程度的降低，并联合利妥昔单抗（R-vCHOP），另外24例患者接受了R-miniCHOP治疗。12例R-vCHOP和16例R-miniCHOP患者完成了化疗周期。R-vCHOP组和R-miniCHOP组的估计2年无进展生存率和总生存率分别为53%和39%（P = 0.92）以及53%和48%（P = 0.95）。体能状态≥2、乳酸脱氢酶水平>正常、血清白蛋白≤3.5 g/dL、C反应蛋白≥2.0 mg/dL、年龄调整后的国际预后评分2/3以及退出化疗周期与生存不良相关。R-miniCHOP组在第二个或后续周期中化疗相关住院的频率显著较低。
R-vCHOP和R-miniCHOP对年龄≥80岁的侵袭性B-NHL患者的疗效相似。R-miniCHOP治疗观察到的住院频率降低对高龄患者有益。
