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de Pádua Covas Lage LA, De Vita RN, de Oliveira Alves LB, Jacomassi MD, Culler HF, Reichert CO, de Freitas FA, Rocha V, Siqueira SAC, de Oliveira Costa R, Pereira J. Predictors of Survival, Treatment Modalities, and Clinical Outcomes of Diffuse Large B-Cell Lymphoma in Patients Older Than 70 Years Still an Unmet Medical Need in 2024 Based on Real-World Evidence. Cancers (Basel) 2024; 16:1459. [PMID: 38672542 PMCID: PMC11048621 DOI: 10.3390/cancers16081459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) especially affects the older population. Old (≥60 years) and very old age (≥80 years) DLBCL patients often present high-risk molecular alterations, lower tolerability to conventional immunochemotherapy, and poor clinical outcomes. In this scenario, attenuated therapeutic strategies, such as the R-MiniCHOP and R-MiniCHOP of the elderly regimens, have emerged for this particularly fragile population. However, the responses, clinical outcomes, and toxicities of these regimens currently remain poorly understood, mainly because these individuals are not usually included in controlled clinical trials. METHODS This retrospective, observational, and single-center real-world study included 185 DLBCL, NOS patients older than 70 years treated at the largest oncology center in Latin America from 2009 to 2020. We aimed to assess the outcomes, determine survival predictors, and compare responses and toxicities between three different primary therapeutic strategies, including the conventional R-CHOP regimen and the attenuated R-MiniCHOP and R-MiniCHOP of the elderly protocols. RESULTS The median age at diagnosis was 75 years (70-97 years), and 58.9% were female. Comorbidities were prevalent, including 19.5% with immobility, 28.1% with malnutrition, and 24.8% with polypharmacy. Advanced clinical stage was observed in 72.4%, 48.6% had bulky disease ≥7 cm, 63.2% had B-symptoms, and 67.0% presented intermediate-high/high-risk IPI. With a median follow-up of 6.3 years, the estimated 5-year OS and PFS were 50.2% and 44.6%, respectively. The R-MiniCHOP of the elderly regimen had a lower ORR (p = 0.040); however, patients in this group had higher rates of unfavorable clinical and laboratory findings, including hypoalbuminemia (p = 0.001), IPI ≥ 3 (p = 0.013), and NCCN-IPI ≥ 3 (p = 0.002). Although associated with higher rates of severe neutropenia (p = 0.003), the R-CHOP regimen promoted increased OS (p = 0.003) and PFS (p = 0.005) in comparison to the attenuated protocols. Additionally, age ≥ 75 years, high levels of LDH, B-symptoms, advanced clinical stage (III/IV), neutrophilia, and low lymphocyte/monocyte ratio were identified as poor prognostic factors in this cohort. CONCLUSIONS In this large and real-life Latin American cohort, we demonstrated that patients with DLBCL, NOS older than 70 years still do not have satisfactory clinical outcomes in 2024, with half of cases not reaching 5 years of life expectancy after diagnosis. Although the conventional R-CHOP offers response and survival advantages over attenuated regimens, its myelotoxicity is not negligible. Therefore, the outcomes reported and the prognostic factors here identified may assist clinicians in the appropriate selection of therapeutic strategies adapted to the risk for old and very old DLBCL patients.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Rita Novello De Vita
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Lucas Bassolli de Oliveira Alves
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Mayara D’Auria Jacomassi
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Cadiele Oliana Reichert
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Fábio Alessandro de Freitas
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Fundação Pró-Sangue, Blood Bank of São Paulo, São Paulo 05403000, Brazil
- Department of Hematology & Hemotherapy, Churchill Hospital, Oxford University, Oxford OX3 7LE, UK
| | | | - Renata de Oliveira Costa
- Department of Hematology & Hemotherapy, Faculty of Medicine, Centro Universitário Lusíada (Unilus), Santos 11045101, Brazil;
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
| | - Juliana Pereira
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
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Baeza-Velasco C, Baguet F, Allart P, Aguerre C, Sultan S, Ninot G, Soubeyran P, Cousson-Gelie F. Major depressive disorder and associated factors in elderly patients with non-Hodgkin’s lymphoma. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2016.1264879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Carolina Baeza-Velasco
- Institut de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA, Paris, France
| | - Fanny Baguet
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Priscilla Allart
- Université de Bordeaux, Laboratoire Psychologie Santé et Qualité de Vie EA, Bordeaux, France
| | - Colette Aguerre
- Université François Rabelais, Laboratoire Psychologie des Ages de la Vie EA, Tours, France
| | - Serge Sultan
- Université de Montréal, CHU Sainte-Justine, QC, Canada
| | - Gregory Ninot
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Pierre Soubeyran
- Departement d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Florence Cousson-Gelie
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
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Brugger W, Ghielmini M. Bendamustine in indolent non-Hodgkin's lymphoma: a practice guide for patient management. Oncologist 2013; 18:954-64. [PMID: 23900001 DOI: 10.1634/theoncologist.2013-0079] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
For patients with advanced indolent non-Hodgkin's lymphoma (NHL) or elderly patients with mantle cell lymphoma (MCL), the recently reported results of the German StiL NHL-1 2003 and the international BRIGHT phase III trials showed that, as first-line treatment, the combination of bendamustine and rituximab is at least as effective as rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone or rituximab/cyclophosphamide/vincristine/prednisone, possibly with a better therapeutic index. Bendamustine is therefore increasingly used in clinical practice. Because bendamustine has been used for many years in Germany and in Switzerland, our institutions have had extensive experience with bendamustine, both as a single agent and in combination with rituximab. In this comprehensive review, we summarize the most important clinical data from phase II/III trials with bendamustine in patients with indolent NHL and MCL, both in the relapsed/refractory setting and in the first-line setting. In addition, this review provides practical advice on how to optimally manage bendamustine therapy in patients with NHL.
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Affiliation(s)
- Wolfram Brugger
- Department of Hematology, Oncology, and Palliative Care, Schwarzwald-Baar Clinic, Academic Teaching Hospital, University of Freiburg, Villingen-Schwenningen, Germany.
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Klastersky J, Gombos A, Georgala A, Awada A. Prevention of neutropenia-related events in elderly patients with hematological cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aging of the population makes it necessary to define more precisely the needs of elderly patients in terms of anticancer therapy as the number of older cancer patients is expected to increase. There is evidence that many elderly cancer patients can benefit from relatively aggressive treatments, provided major side effects can be prevented or treated. In patients with hematological malignancies, infection is the most common and threatening complication resulting from chemotherapy administration. Discussion of the prevention of infection in the setting described above is the aim of this paper.
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Affiliation(s)
| | - Andrea Gombos
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
| | - Aspasia Georgala
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
| | - Ahmad Awada
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger-Bordet 1, 1000 Brussels, Belgium
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Bölke E, Peiper M, Matuschek C, Schieren G, Glombick R, Förster C, Budach W, Orth K. Extranodal diffuse non hodgkin lymphoma in the thigh. Eur J Med Res 2010; 15:367-8. [PMID: 20947475 PMCID: PMC3458703 DOI: 10.1186/2047-783x-15-8-367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Diffuse large B-cell lymphoma usually starts as a rapidly growing mass in an internal lymph node and can grow in other areas such as the bone or intestines. About 1/3 of these lymphomas are confined to one part of the body when they are localized. In the case of a 78-year-old man, an extensive tumour was located on the right thigh. Biopsies of the tumour revealed diffuse proliferation of large lymphoid cells which have totally affected the normal architecture of striated muscle. The patient received multimodality treatment including chemotherapy of the CHOP regimen and adjuvant radiotherapy. Despite this being a fast growing lymphoma, about 3 out of 4 people will have no signs of disease after initial treatment, and about half of all people with this lymphoma are cured with therapy.
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Affiliation(s)
- Edwin Bölke
- Klinik für Strahlentherapie und Radiologische Onkologie, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany.
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