Maja Bech Juul1, Pernille Hammershoej Jensen2, Henriette Engberg3, Sonja Wehberg3, Andriette Dessau-Arp4, Donika Haziri5, Helene Bjoerg Kristensen6, Joachim Baech7, Lene Schurmann8, Michael Roost Clausen9, Rebecca Valentin10, Lene Meldgaard Knudsen11, Lars Munksgaard2, Tarec Christoffer El-Galaly7, Henrik Frederiksen12, Thomas Stauffer Larsen12. 1. Department of Hematology, Odense University Hospital, Denmark; Academy of Geriatric Cancer Research, Odense University Hospital, Denmark. Electronic address: majajuul@dadlnet.dk. 2. Department of Hematology, Zealand University Hospital, Roskilde, Denmark. 3. Center for Clinical Epidemiology, Odense University Hospital, Denmark; Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 4. Department of Hematology, Sydvestjysk Sygehus, Esbjerg, Denmark. 5. Department of Medicine, Sygehus Soenderjylland, Aabenraa, Denmark. 6. Department of Hematology, Sygehus Lillebaelt, Vejle, Denmark. 7. Department of Hematology, Aalborg University Hospital, Denmark. 8. Department of Medicine, Hospitalsenheden Vest, Holstebro, Denmark. 9. Department of Hematology, Aarhus University Hospital, Denmark. 10. Department of Hematology, Rigshospitalet, Copenhagen, Denmark. 11. Department of Hematology, Herlev Hospital, Denmark. 12. Department of Hematology, Odense University Hospital, Denmark; Academy of Geriatric Cancer Research, Odense University Hospital, Denmark.
Abstract
BACKGROUND: Optimal treatment strategy for the oldest patients with diffuse large B-cell lymphoma (DLBCL) remains controversial, as this group often is precluded from clinical trials, and population-based studies are limited. METHODS: All Danish DLBCL-patients ≥75 years diagnosed from 2003 to 2012 were identified, using the Danish National Lymphoma Registry (LYFO). Information regarding baseline characteristics, treatment, comorbidities and outcomes was retrieved from LYFO, the Danish National health registries and medical records. Patients were stratified by age (75-79; 80-84 and 85 + years), comorbidity score and treatment modality (standard treatment [R-CHOP/CHOP-like], less intensive regimens or palliative treatment). FINDINGS: A total of 1011 patients were included. Standard treatment was initiated in 64%, ranging from 83% among patients aged 75-79 years to 32% among patient aged 85 + years. With standard treatment, median overall survival (OS) estimates were 4·6, 2·6, and 1·9 years for the age groups 75-79, 80-84 and 85+ years. Among patient aged 75-79 and 80-84 years, OS was superior with standard treatment, although high comorbidity scores attenuated this association. Among patients aged 85+ years, survival was not influenced by treatment intensity. Patients ≥80 years had similar OS regardless of intended (R-)CHOP dosing, whereas patients of 75-79 years scheduled for full dose had higher OS. Standard treatment was not associated with increased hospitalisation. INTERPRETATION: Standard treatment is feasible with good outcomes in a large proportion of elderly DLBCL-patients. Planned dose reduction in patients aged ≥80 years had no negative impact on OS.
BACKGROUND: Optimal treatment strategy for the oldest patients with diffuse large B-cell lymphoma (DLBCL) remains controversial, as this group often is precluded from clinical trials, and population-based studies are limited. METHODS: All Danish DLBCL-patients ≥75 years diagnosed from 2003 to 2012 were identified, using the Danish National Lymphoma Registry (LYFO). Information regarding baseline characteristics, treatment, comorbidities and outcomes was retrieved from LYFO, the Danish National health registries and medical records. Patients were stratified by age (75-79; 80-84 and 85 + years), comorbidity score and treatment modality (standard treatment [R-CHOP/CHOP-like], less intensive regimens or palliative treatment). FINDINGS: A total of 1011 patients were included. Standard treatment was initiated in 64%, ranging from 83% among patients aged 75-79 years to 32% among patient aged 85 + years. With standard treatment, median overall survival (OS) estimates were 4·6, 2·6, and 1·9 years for the age groups 75-79, 80-84 and 85+ years. Among patient aged 75-79 and 80-84 years, OS was superior with standard treatment, although high comorbidity scores attenuated this association. Among patients aged 85+ years, survival was not influenced by treatment intensity. Patients ≥80 years had similar OS regardless of intended (R-)CHOP dosing, whereas patients of 75-79 years scheduled for full dose had higher OS. Standard treatment was not associated with increased hospitalisation. INTERPRETATION: Standard treatment is feasible with good outcomes in a large proportion of elderly DLBCL-patients. Planned dose reduction in patients aged ≥80 years had no negative impact on OS.
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