Department of Internal Medicine III, Hematology & Oncology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
BMC Cancer. 2018 Oct 19;18(1):1000. doi: 10.1186/s12885-018-4885-5.
Rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is broadly accepted as standard for the treatment of diffuse large B-cell lymphoma (DLBCL). Nevertheless, there is sparsely data concerning the management of elderly patients.
We performed a retrospective study of treatment with rituximab and low-dose trofosfamide in elderly patients (≥ 75 years) with DLBCL who were not suitable for R-CHOP or R-CHOP-like regimens or who did not consent to aggressive treatment. The choice regarding the qualification for R-CHOP or R-CHOP-like regimen was left to the estimation of the treating physicians.
Eleven patients with a median age of 83 years (range, 75-90 years) were included. The age-adjusted international prognostic index was low risk in one patient, low-intermediate in four patients, high-intermediate in three patients, and high risk in 3 patients. All patients were evaluable for response. Five patients (45%) achieved a complete response, three (27%) a partial response, one (9%) stable disease, and two (18%) progressive disease. The estimated 1-yr overall survival was 54.5%, and the estimated 1-yr progression-free survival 45.5%, however, three patients (27%) were alive without evidence of disease at 16-20 months from start of treatment. Main toxicity was leukopenia (36% grade III or IV), whereas grade III/IV non-hematological adverse events did not occur.
Due to its potency and low toxicity, trofosfamide/rituximab might represent an alternative therapy for DLBCL of elderly patients not suitable for R-CHOP. This observation, however, should be confirmed in a larger patient population within a prospective clinical trial.
利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）被广泛接受为弥漫性大 B 细胞淋巴瘤（DLBCL）的标准治疗方法。然而，关于老年患者的治疗数据仍然很少。
我们对不适合接受 R-CHOP 或类似 R-CHOP 方案治疗或不同意采用积极治疗的老年（≥75 岁）DLBCL 患者进行了利妥昔单抗和低剂量替莫唑胺治疗的回顾性研究。R-CHOP 或类似 R-CHOP 方案的资格选择取决于治疗医生的评估。
11 例患者的中位年龄为 83 岁（范围为 75-90 岁）。1 例患者的年龄调整国际预后指数为低危，4 例为低中危，3 例为高中危，3 例为高危。所有患者均可评价疗效。5 例（45%）患者达到完全缓解，3 例（27%）患者达到部分缓解，1 例（9%）患者疾病稳定，2 例（18%）患者疾病进展。估计 1 年总生存率为 54.5%，估计 1 年无进展生存率为 45.5%，然而，有 3 例（27%）患者在治疗开始后 16-20 个月时仍无疾病证据存活。主要毒性为白细胞减少（36%为 3 级或 4 级），但未发生 3 级或 4 级非血液学不良事件。
由于替莫唑胺/利妥昔单抗具有疗效高、毒性低的特点，可能成为不适合 R-CHOP 的老年 DLBCL 患者的替代治疗方法。然而，这一观察结果需要在更大的患者群体中进行前瞻性临床试验来证实。
