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Michalarea V, Low R, Kirkwood A, Harrington P, Yadollahi S, Djebbari F, Gleeson M, Cwynarski K, Lambert J, Chau I, Wrench D, Eyre T, Davies A, Ardeshna K, Cunningham D, Fields P. EXCELLENT OUTCOMES USING RITUXIMAB, GEMCITABINE, CYCLOPHOSPHAMIDE, VINCRISTINE, PREDNISOLONE (R-GCVP) IN PATIENTS WITH DLBCL AND CARDIAC COMORBIDITIES. Hematol Oncol 2019. [DOI: 10.1002/hon.97_2631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- V. Michalarea
- Department of Medicine; GI and Lymphoma Oncology Unit, The Royal Marsden NHS Foundation Trust; London United Kingdom
| | - R. Low
- Department of Haematology; University College Hospitals NHS Foundation Trust; London United Kingdom
| | - A.A. Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre; University College Hospitals NHS Foundation Trust; London United Kingdom
| | - P. Harrington
- Department of Haematology; Guys and St.Thomas' NHS Foundation Trust; London United Kingdom
| | - S. Yadollahi
- Department of Haematology; University Hospitals Southampton NHS Foundation Trust; Southampton United Kingdom
| | - F. Djebbari
- Department of Cancer Pharmacy; Oxford University Hospitals NHS Foundation Trust; Oxford United Kingdom
| | - M. Gleeson
- Department of Haematology; Guys and St.Thomas' NHS Foundation Trust; London United Kingdom
| | - K. Cwynarski
- Department of Haematology; University College Hospitals NHS Foundation Trust; London United Kingdom
| | - J. Lambert
- Department of Haematology; University College Hospitals NHS Foundation Trust; London United Kingdom
| | - I. Chau
- Department of Medicine; GI and Lymphoma Oncology Unit, The Royal Marsden NHS Foundation Trust; London United Kingdom
| | - D. Wrench
- Department of Haematology; Guys and St.Thomas' NHS Foundation Trust; London United Kingdom
| | - T.A. Eyre
- Department of Haematology; Oxford University Hospitals NHS Foundation Trust; Oxford United Kingdom
| | - A. Davies
- Cancer Sciences Division; University Hospital Southampton NHS Foundation Trust; Southampton United Kingdom
| | - K.M. Ardeshna
- Department of Haematology; University College Hospitals NHS Foundation Trust; London United Kingdom
| | - D. Cunningham
- Department of Medicine; GI and Lymphoma Oncology Unit, The Royal Marsden NHS Foundation Trust; London United Kingdom
| | - P. Fields
- Department of Haematology; Guys and St.Thomas' NHS Foundation Trust; London United Kingdom
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Eyre TA, Martinez-Calle N, Hildyard C, Eyre DW, Plaschkes H, Griffith J, Wolf J, Fields P, Gunawan A, Oliver R, Djebbari F, Booth S, McMillan A, Fox CP, Bishton MJ, Collins GP, Hatton CSR. Impact of intended and relative dose intensity of R-CHOP in a large, consecutive cohort of elderly diffuse large B-cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age. J Intern Med 2019; 285:681-692. [PMID: 30811713 DOI: 10.1111/joim.12889] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The increasing incidence of diffuse large B-cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co-morbidity, frailty, and reduced organ and physiological reserve contribute to treatment-related complications. The optimal dose intensity of R-CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear. OBJECTIVES AND METHODS We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009-2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. RESULTS Porgression-free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70-79 years (P < 0.001). In contrast, 2-year cumulative relapse incidence, when accounting for non-relapse mortality as a competing risk, was no different between 70-79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS-G: 0-6 vs. >6) (P = 0.27). In 70-79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI <80% vs. ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70-79 years with an IDI <80% (vs. >80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32). CONCLUSION 'R-mini-CHOP' provides adequate lymphoma-specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.
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Affiliation(s)
- T A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N Martinez-Calle
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Hildyard
- Department of Haematology, Milton Keynes Hospital, Milton Keynes, UK
| | - D W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Big Data Institute, University of Oxford, Oxford, UK
| | - H Plaschkes
- Oxford University Medical School, Oxford, UK
| | - J Griffith
- Department of Haematology, Great Western Hospital, Swindon, UK
| | - J Wolf
- Department of Haematology, Great Western Hospital, Swindon, UK
| | - P Fields
- Department of Haematology, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - A Gunawan
- Department of Haematology, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - R Oliver
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F Djebbari
- Department of Cancer Pharmacy, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Booth
- Department of Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - A McMillan
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M J Bishton
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G P Collins
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C S R Hatton
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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