Kenneth R Carson1, Peter Riedell2, Ryan Lynch2, Chadi Nabhan3, Tanya M Wildes4, Weijian Liu5, Arun Ganti6, Ryan Roop5, Kristen M Sanfilippo5, Katiuscia O'Brian5, Jingxia Liu7, Nancy L Bartlett8, Amanda Cashen8, Nina Wagner-Johnston8, Todd A Fehniger8, Graham A Colditz9. 1. Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA; Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA; Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. Electronic address: kcarson@dom.wustl.edu. 2. Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. 3. Division of Hematology/Oncology, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068, USA. 4. Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA; Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. 5. Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA; Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. 6. Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO 63103, USA. 7. Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. 8. Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA. 9. Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
Abstract
OBJECTIVES: While anthracycline-based treatment can cure diffuse large B-cell lymphoma, most patients over age 80 do not receive doxorubicin due to toxicity concerns. This study evaluated this practice, as patients age 80 and older are largely excluded from clinical trials. The primary outcome of interest was overall survival. Secondary outcomes included treatment-related mortality and anthracycline dose intensity. MATERIALS AND METHODS: We assembled a cohort of 530 newly diagnosed diffuse large B-cell lymphoma patients age 80 or older diagnosed within United States Veterans Health Administration. Treatment and survival information were obtained to determine associations between anthracycline use, dose intensity, treatment-related mortality and overall survival. RESULTS: Of the 530 patients, 285 received systemic treatment and 193 received an anthracycline. After controlling for potential confounders, rituximab decreased mortality (hazard ratio, 0.62; 95% confidence interval [CI]: 0.44-0.88), while doxorubicin was not significantly associated with mortality (hazard ratio, 0.87; 95% CI: 0.64-1.17). Completion of treatment with anthracycline dose intensity ≥85% of expected was only 14%. Patients treated with anthracycline dose intensity <85% had better one year survival compared to those treated at ≥85% (70% vs. 59%, p=0.029). CONCLUSION: These results suggest that full dose anthracycline therapy may be less important in the treatment of diffuse large B-cell lymphoma patients over age 80. The low frequency of completion of full dose intensity treatment suggests that standard doses are an unrealistic standard of care for patients this age. Alternate treatment strategies and risk stratification should be considered for these patients. Published by Elsevier Ltd.
OBJECTIVES: While anthracycline-based treatment can cure diffuse large B-cell lymphoma, most patients over age 80 do not receive doxorubicin due to toxicity concerns. This study evaluated this practice, as patients age 80 and older are largely excluded from clinical trials. The primary outcome of interest was overall survival. Secondary outcomes included treatment-related mortality and anthracycline dose intensity. MATERIALS AND METHODS: We assembled a cohort of 530 newly diagnosed diffuse large B-cell lymphomapatients age 80 or older diagnosed within United States Veterans Health Administration. Treatment and survival information were obtained to determine associations between anthracycline use, dose intensity, treatment-related mortality and overall survival. RESULTS: Of the 530 patients, 285 received systemic treatment and 193 received an anthracycline. After controlling for potential confounders, rituximab decreased mortality (hazard ratio, 0.62; 95% confidence interval [CI]: 0.44-0.88), while doxorubicin was not significantly associated with mortality (hazard ratio, 0.87; 95% CI: 0.64-1.17). Completion of treatment with anthracycline dose intensity ≥85% of expected was only 14%. Patients treated with anthracycline dose intensity <85% had better one year survival compared to those treated at ≥85% (70% vs. 59%, p=0.029). CONCLUSION: These results suggest that full dose anthracycline therapy may be less important in the treatment of diffuse large B-cell lymphomapatients over age 80. The low frequency of completion of full dose intensity treatment suggests that standard doses are an unrealistic standard of care for patients this age. Alternate treatment strategies and risk stratification should be considered for these patients. Published by Elsevier Ltd.
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