Comparative Effectiveness of R-miniCOMP Versus R-miniCHOP in Older Non-Fit Patients With Diffuse Large B-Cell Lymphoma: Insights From a “Fondazione Italiana Linfomi” Cohort Study

IF 3.3 4区医学 Q2 HEMATOLOGY

Hematological Oncology Pub Date : 2025-05-13 DOI:10.1002/hon.70099

Alberto Bavieri, Sara Veronica Usai, Michele Merli, Alice Di Rocco, Federica Cavallo, Vittorio Ruggero Zilioli, Manuela Zanni, Flenghi Leonardo, Dario Marino, Annalisa Arcari, Emanuele Cencini, Guido Gini, Barbara Botto, Alessandra Tucci, Clara Deambrogi, Plenteda Caterina, Bianchi Maria Paola, Stefan Hohaus, Manuel Gotti, Benedetta Puccini, Daniela Dessì, Coscia Marta, Luigi Petrucci, Simone Ragaini, Emanuela Chimienti, Luigi Marcheselli, Caterina Mammi, Stefano Luminari, Michele Spina, Francesco Merli

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引用次数: 0

Abstract

The R-miniCHOP regimen is the standard first-line treatment for diffuse large B-cell lymphoma (DLBCL) in older unfit or frail patients. Recent research suggests that replacing doxorubicin with non-PEGylated liposomal doxorubicin (NPLD) is safe and effective for DLBCL. However, the outcomes of DLBCL patients receiving NPLD as part of a reduced-intensity regimen approach have yet to be investigated. This study aimed to assess non-fit DLBCL patients enrolled in the Elderly Project (EP) conducted by the Fondazione Italiana Linfomi (FIL) who were treated with R-miniCHOP or R-miniCOMP. The primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS), respectively. Of the 1163 cases within the EP cohort, we identified 176 patients (18%) who resulted unfit or frail at simplified geriatric assessment (sGA) and received either R-miniCHOP (89 cases; 51%) or R-miniCOMP (87 cases; 49%). Both cohorts exhibited similar clinical characteristics, a similar distribution of unfit and frail cases using the sGA and similar Elderly Prognostic Index (EPI) scores. After a median follow-up of 28 months, the 3-year OS and PFS rates were 61% and 54% respectively, with no significant difference between R-miniCHOP and R-miniCOMP. Notably, the therapeutic regimen had no significant impact on OS (HR 1.07, 95% CI: 0.63–1.82, p = 0.798) or PFS (HR 1.00, 95% CI: 0.62–1.6, p = 0.999) even after adjusting for propensity score (PS) and inverse probability weighting (IPW). A comprehensive survival analysis within vulnerable geriatric categories (unfit and frail patients) confirmed non-significant variations in predictive efficacy between R-miniCHOP and R-miniCOMP. Of note the independent prognostic role of EPI is confirmed for both OS and PFS. This study suggests that R-miniCHOP is still the preferred treatment for unfit and frail older DLBCL. The role of R-miniCOMP for specific subgroups of older DLBCLs warrants confirmation in larger studies.

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R-miniCOMP与R-miniCHOP治疗老年弥漫性大b细胞淋巴瘤的疗效比较：来自意大利林福米基金会队列研究的见解

R-miniCHOP方案是老年或体弱患者弥漫性大b细胞淋巴瘤（DLBCL）的标准一线治疗方案。最近的研究表明，用非聚乙二醇化脂质体多柔比星（NPLD）替代阿霉素治疗DLBCL是安全有效的。然而，DLBCL患者接受NPLD作为降低强度方案方法的一部分的结果尚未被调查。本研究旨在评估参加由意大利Linfomi基金会（FIL）开展的老年项目（EP）的非适应DLBCL患者，他们接受R-miniCHOP或R-miniCOMP治疗。主要终点和次要终点分别是总生存期（OS）和无进展生存期（PFS）。在EP队列中的1163例病例中，我们确定了176例（18%）患者在简化老年评估（sGA）中结果不适合或虚弱，并接受了R-miniCHOP(89例；51%)或R-miniCOMP(87例；49%)。两个队列表现出相似的临床特征，使用sGA和类似的老年预后指数（EPI）评分的不健康和虚弱病例的相似分布。中位随访28个月后，3年OS和PFS分别为61%和54%，R-miniCHOP和R-miniCOMP之间无显著差异。值得注意的是，即使在调整倾向评分（PS）和逆概率加权（IPW）后，治疗方案对OS （HR 1.07, 95% CI: 0.63-1.82, p = 0.798）或PFS （HR 1.00, 95% CI: 0.62-1.6, p = 0.999）也没有显著影响。一项针对易受伤害的老年患者（不健康和虚弱患者）的综合生存分析证实，R-miniCHOP和R-miniCOMP的预测疗效无显著差异。值得注意的是，EPI对OS和PFS的独立预后作用得到了证实。这项研究表明，R-miniCHOP仍然是不健康和虚弱的老年DLBCL的首选治疗方法。R-miniCOMP在老年dlbcl特定亚组中的作用有待于更大规模的研究证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hematological Oncology 医学-血液学

CiteScore

4.20

自引率

6.10%

发文量

147

审稿时长

>12 weeks

期刊介绍： Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged: -Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders -Diagnostic investigations, including imaging and laboratory assays -Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases -Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies -Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems. Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.