Treating newly diagnosed Diffuse Large B-cell Lymphoma in the elderly patient with R-mini-CHOP: A single centre analytical retrospective observational study.

Q3 Medicine
Medical Journal of Malaysia Pub Date : 2025-05-01
N L Lai, P C Bee
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引用次数: 0

Abstract

Introduction: Diffuse large B-cell lymphoma (DLBCL) forms the bulk of non-Hodgkin lymphoma (NHL) cases encountered in clinical practice among the elderly. For the majority of cases of DLBCL, treatment comprising of Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone (R-CHOP) is suggested as first line chemotherapy. However, chemotherapy in the elderly population may be hampered by multiple factors, including reduced bone marrow reserves, significant comorbidities, and greater side effects from chemotherapy. Treatment as such aims to offer disease control and prolong life whilst minimising treatment related complications in this group of patients. Treatment with R-mini-CHOP, a reduced dose form of R-CHOP offers survival benefits and is recommended for treatment of elderly DLBCL patients and those who are frail. Our study examined local Malaysian experience of treating the newly diagnosed elderly DLBCL patient with R-mini- CHOP.

Materials and methods: We retrieved retrospective data of all DLBCL patients aged >65 years old from the electronic medical records in Pusat Perubatan Universiti Malaya who received R-mini-CHOP. Treatment response was assessed by the overall response rate (ORR), defined as the proportion of patients attaining complete and partial remission after six cycles of treatment. We excluded patients with transformed lymphomas and relapsed refractory disease. For secondary analysis, we examined patients' treatment response according to their baseline demographic characteristics, development of complications during therapy as well as their survival in months from diagnosis.

Results: Our study identified 33 patients in the period of January 2017 till June 2023. The mean age of the sample cohort was 78 years old (Range from 66 to 86 years old). Majority of the samples had advanced stage lymphoma at initial diagnosis with n=21/33 (63.6%) having stage III and IV disease. At the end of treatment, one patient did not have assessment scans and hence was excluded from analysis. n=16/32 patients (50.0%) had attained ORR when analysed by intention to treat, n=14/32 (43.7%) attained complete response and n=2/32 (6.25%) attained partial response. When analysed for treatment response, those who attained ORR were more likely to have Stage 1 or 2 disease (p value = 0.028) and had statistically significant increased progression free survival (28.5 vs 5.5 months, p value <0.01) and overall survival (28.5 vs 9.0 months, p value = 0.03) compared to those who did not attain ORR. In terms of treatment associated complications, n=9/32 (28.1%) of patients developed severe infection necessitating hospitalization, n=14/32 (43.7%) developed at least Grade 2 and above cytopenias, and n=13/32 (41.6%) developed some other adverse side effects, most of which were mild to moderate in terms of severity.

Conclusion: The ORR for our patients treated with R-mini- CHOP was lower than other cohorts. We hypothesise that Rmini- CHOP alone may not offer adequate lymphoma control in our sample, especially for treatment of advanced stage DLBCL. Age alone is not an objective assessment of suitability for treatment; therefore, we suggest the use of geriatric prognostication tools to better ascertain patient groups who would benefit from full dose R-CHOP chemotherapy to improve response and survival.

R-mini-CHOP治疗老年弥漫性大b细胞淋巴瘤:一项单中心分析回顾性观察研究
导语:弥漫性大b细胞淋巴瘤(DLBCL)构成了临床上老年人非霍奇金淋巴瘤(NHL)病例的主体。对于大多数DLBCL病例,建议采用利妥昔单抗、环磷酰胺、阿霉素、长春新碱和强的松龙(R-CHOP)作为一线化疗。然而,老年人的化疗可能受到多种因素的阻碍,包括骨髓储备减少、明显的合并症和化疗的更大副作用。治疗的目的是提供疾病控制和延长生命,同时尽量减少与治疗相关的并发症。R-mini-CHOP是一种减少剂量的R-CHOP,可提高生存率,推荐用于老年DLBCL患者和体弱患者的治疗。我们的研究考察了马来西亚当地用R-mini- CHOP治疗新诊断的老年DLBCL患者的经验。材料和方法:我们从马来亚大学电子病历中检索了所有接受R-mini-CHOP治疗的年龄在bb0 ~ 65岁的DLBCL患者的回顾性资料。通过总缓解率(ORR)来评估治疗反应,总缓解率定义为6个治疗周期后获得完全和部分缓解的患者比例。我们排除了转化淋巴瘤和复发难治性疾病的患者。为了进行二次分析,我们根据患者的基线人口统计学特征、治疗期间并发症的发生以及诊断后数月的生存率来检查患者的治疗反应。结果:我们的研究在2017年1月至2023年6月期间确定了33例患者。样本队列的平均年龄为78岁(范围从66岁到86岁)。大多数样本在初始诊断时为晚期淋巴瘤,n=21/33(63.6%)为III期和IV期疾病。在治疗结束时,一名患者没有进行评估扫描,因此被排除在分析之外。意向分析时,n=16/32例患者(50.0%)达到ORR, n=14/32例(43.7%)达到完全缓解,n=2/32例(6.25%)达到部分缓解。当分析治疗反应时,达到ORR的患者更有可能患有1期或2期疾病(p值= 0.028),并且无进展生存期有统计学意义的增加(28.5个月vs 5.5个月,p值)。结论:我们的R-mini- CHOP治疗患者的ORR低于其他队列。我们假设在我们的样本中,单独使用Rmini- CHOP可能无法提供足够的淋巴瘤控制,特别是对于晚期DLBCL的治疗。年龄本身并不是对治疗适宜性的客观评价;因此,我们建议使用老年预后工具来更好地确定患者群体,他们将从全剂量R-CHOP化疗中获益,以提高疗效和生存率。
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
Medical Journal of Malaysia
Medical Journal of Malaysia Medicine-Medicine (all)
CiteScore
1.20
自引率
0.00%
发文量
165
期刊介绍: Published since 1890 this journal originated as the Journal of the Straits Medical Association. With the formation of the Malaysian Medical Association (MMA), the Journal became the official organ, supervised by an editorial board. Some of the early Hon. Editors were Mr. H.M. McGladdery (1960 - 1964), Dr. A.A. Sandosham (1965 - 1977), Prof. Paul C.Y. Chen (1977 - 1987). It is a scientific journal, published quarterly and can be found in medical libraries in many parts of the world. The Journal also enjoys the status of being listed in the Index Medicus, the internationally accepted reference index of medical journals. The editorial columns often reflect the Association''s views and attitudes towards medical problems in the country. The MJM aims to be a peer reviewed scientific journal of the highest quality. We want to ensure that whatever data is published is true and any opinion expressed important to medical science. We believe being Malaysian is our unique niche; our priority will be for scientific knowledge about diseases found in Malaysia and for the practice of medicine in Malaysia. The MJM will archive knowledge about the changing pattern of human diseases and our endeavours to overcome them. It will also document how medicine develops as a profession in the nation. We will communicate and co-operate with other scientific journals in Malaysia. We seek articles that are of educational value to doctors. We will consider all unsolicited articles submitted to the journal and will commission distinguished Malaysians to write relevant review articles. We want to help doctors make better decisions and be good at judging the value of scientific data. We want to help doctors write better, to be articulate and precise.
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