Kayamori Kensuke, Shono Katsuhiro, Onoda Masahiro, Yokota Akira
a Department of Hematology , Chiba Aoba Municipal Hospital , Chiba , Japan.
b Department of Hematology , Chiba University Hospital , Chiba , Japan.
Hematology. 2019 Dec;24(1):52-59. doi: 10.1080/10245332.2018.1509461. Epub 2018 Aug 11.
Chemoimmunotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone combined with rituximab (R-CHOP) is currently the first-line therapy for diffuse large B-cell lymphoma (DLBCL). However, management of elderly patients is challenging and often requires dose reductions or prolonged treatment intervals. We investigated the proper dose of R-CHOP for them.
At our institute, for DLBCL patients aged 65-79 and ≥80 years, we had reduced CHOP dose to 5/6 and 7/12, respectively, and retrospectively evaluated the reduced-dose R-CHOP.
Although the median age in the standard, 5/6, and 7/12-dose groups was 57, 73, and 84 years, respectively (p < 0.001), the 3-year event-free survival (EFS) rate did not differ between the standard and 5/6-dose groups (60.2 and 56.7%); however, 7/12-dose group had significantly inferior survival (25.9%). When patients aged 60-80 were evaluated, no difference in EFS was observed between the standard and 5/6-dose groups using the same international prognostic index. The neutrophil nadir and the frequency of infection were comparable among the three dose groups.
Reduced-dose R-CHOP chemotherapy is a promising treatment for elderly patients with DLBCL in terms of efficacy and toxicity.
环磷酰胺、多柔比星、长春新碱和泼尼松龙联合利妥昔单抗（R-CHOP）的化疗免疫疗法目前是弥漫性大B细胞淋巴瘤（DLBCL）的一线治疗方法。然而，老年患者的治疗具有挑战性，通常需要降低剂量或延长治疗间隔。我们研究了适合他们的R-CHOP剂量。
在我们研究所，对于65 - 79岁和≥80岁的DLBCL患者，我们分别将CHOP剂量降低至5/6和7/12，并对减量的R-CHOP进行回顾性评估。
虽然标准剂量组、5/6剂量组和7/12剂量组的中位年龄分别为57岁、73岁和84岁（p < 0.001），但标准剂量组和5/6剂量组的3年无事件生存率（EFS）无差异（分别为60.2%和56.7%）；然而，7/12剂量组的生存率明显较差（25.9%）。当评估60 - 80岁的患者时，使用相同的国际预后指数，标准剂量组和5/6剂量组的EFS无差异。三个剂量组的中性粒细胞最低点和感染频率相当。
就疗效和毒性而言，减量的R-CHOP化疗是老年DLBCL患者的一种有前景的治疗方法。
