Tolerability and long-term survival of fragile or older patients with diffuse large B cell lymphoma (DLBCL) not otherwise specified by R-CDOP

Abstract

Abstract Introduction: According to Surveillance, Epidemiology, and End Results data, Diffuse Large B-Cell Lymphoma (DLBCL) is diagnosed at the median age of 67. Treatment decisions amongst older patients, especially over 75-year-old are challenging due to the poor tolerability of standard R-CHOP and the compromised efficacy of R-mini-CHOP. Patients and Methods: We retrospectively analyzed data from patients with DLBCL not otherwise specified (NOS) who were treated with frontline R-CDOP. The regimen included Rituximab 375mg/m2, Cyclophosphamide 750mg/m2, liposomal doxorubicin 30mg/m2 on day 1 and prednisone 100mg day 1-5, every 21 days a cycle, followed by granulocyte colony stimulating factor and preventive antibiotics support. Patients with transformed or other entities of DLBCL, or RCDOP as second line were excluded from this study. Clinical data included complete blood counts with differential, chemistry and clinical signs of cardiac failure, transfusion requirement, hospitalizations, positron emission tomography scans and clinical signs and symptoms of disease were analyzed. Deaths without evidence of disease relapse were counted as events Results: Ten patients' data (2 females, 8 males; 1 diagnosed at age of 47 with heart failure, the other 9, age from 71-86) were analyzed, 1 patients completed 4 cycles, one 5 cycles and the other 8 completed 6 cycles, none was given dose reduction. There was no worsening of cardiac congestion noted or events that compromised treatment. One showed partial response, the other 9 showed durable complete response. Three patients died without evidence of disease relapse (one from demenitia and 2 from secondary malignancies), 2 died from disease relapse. Overall survival and relapse-free survival at 5 years are both 50%. No patient died from the treatment. Conclusions: RCDOP as frontline appears tolerable for olderly with DLBCL NOS and gives durable response and long-term survival.