Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy.
UOC di Medicina Interna IRCCS Istituto Auxologico Italiano Milano, Fondazione Matarelli Milan.
Anticancer Drugs. 2021 Mar 1;32(3):323-329. doi: 10.1097/CAD.0000000000001027.
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) has been considered the standard of care for diffuse large B cell lymphoma (DLBCL) patients, including in the elderlies, and represent the current standard treatment. Ineligibility for R-CHOP-like treatments seems to be associated with shorter survival. Recent studies have shown that bendamustine and rituximab is linked, in elderly patients affected by DLBCL. Here we report our experience with BR in 40 elderly frail patients affected by DLBCL ineligibles for R-CHOP. The OOR was 77.5%, with 22 complete responses and 9 partial responses statistical analysis showed no significant difference in overall survival (OS) between patients aged 80 years and older and patients younger than 80 years (6·4 vs. 10·2 months, respectively, P = 0·43). Complete responders were more likely patients with good performance status, (ECOG 0-1) 13 patients (60%), 9 patients (40%) were ECOG 2; of the 9 patients who achieved partial response, 7 patients had ECOG 0-1 and 2 patients had ECOG 2. Four patients had stable disease. Progression-free survival (PFS) median PFS was 13.5 months. These preliminary results showed that bendamustine and rituximab has been associated with high response rates, acceptable toxicity in frail DLBCL patients and high rate of OSS. In older patients with advanced IPI scores, no significant difference in OS were observed between patients aged 80 years and older and patients younger than 80 years. We conclude that bendamustine and rituximab seems to be a reasonable alternative for frail DLBCL patients.
R-CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松）已被认为是弥漫性大 B 细胞淋巴瘤（DLBCL）患者的标准治疗方法，包括老年人，也是目前的标准治疗方法。不适合接受 R-CHOP 样治疗的患者似乎与生存期更短有关。最近的研究表明，在患有 DLBCL 的老年患者中，苯达莫司汀和利妥昔单抗联合使用。在这里，我们报告了 40 例不适合接受 R-CHOP 治疗的虚弱老年 DLBCL 患者接受 BR 治疗的经验。ORR 为 77.5%，22 例完全缓解，9 例部分缓解。统计分析显示，80 岁及以上患者与 80 岁以下患者的总生存期（OS）无显著差异（分别为 6.4 个月和 10.2 个月，P=0.43）。完全缓解者更可能是一般状况良好的患者，13 例（60%）ECOG 0-1，9 例（40%）ECOG 2；9 例部分缓解者中，7 例 ECOG 0-1，2 例 ECOG 2。4 例患者病情稳定。无进展生存期（PFS）中位 PFS 为 13.5 个月。这些初步结果表明，苯达莫司汀和利妥昔单抗联合治疗在虚弱的 DLBCL 患者中具有较高的缓解率、可接受的毒性和较高的总生存率。在 IPI 评分较高的老年患者中，80 岁及以上患者与 80 岁以下患者的 OS 无显著差异。我们得出结论，苯达莫司汀和利妥昔单抗似乎是虚弱的 DLBCL 患者的合理选择。
