T A Eyre1, N Martinez-Calle2, C Hildyard3, D W Eyre4,5, H Plaschkes6, J Griffith7, J Wolf7, P Fields8, A Gunawan8, R Oliver9, F Djebbari10, S Booth11, A McMillan2, C P Fox2, M J Bishton2, G P Collins1, C S R Hatton1. 1. Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 2. Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK. 3. Department of Haematology, Milton Keynes Hospital, Milton Keynes, UK. 4. Nuffield Department of Medicine, University of Oxford, Oxford, UK. 5. Big Data Institute, University of Oxford, Oxford, UK. 6. Oxford University Medical School, Oxford, UK. 7. Department of Haematology, Great Western Hospital, Swindon, UK. 8. Department of Haematology, Guys and St Thomas' Hospitals NHS Foundation Trust, London, UK. 9. Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 10. Department of Cancer Pharmacy, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 11. Department of Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK.
Abstract
BACKGROUND: The increasing incidence of diffuse large B-cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co-morbidity, frailty, and reduced organ and physiological reserve contribute to treatment-related complications. The optimal dose intensity of R-CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear. OBJECTIVES AND METHODS: We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009-2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. RESULTS: Porgression-free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70-79 years (P < 0.001). In contrast, 2-year cumulative relapse incidence, when accounting for non-relapse mortality as a competing risk, was no different between 70-79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS-G: 0-6 vs. >6) (P = 0.27). In 70-79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI <80% vs. ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70-79 years with an IDI <80% (vs. >80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32). CONCLUSION: 'R-mini-CHOP' provides adequate lymphoma-specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.
BACKGROUND: The increasing incidence of diffuse large B-cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co-morbidity, frailty, and reduced organ and physiological reserve contribute to treatment-related complications. The optimal dose intensity of R-CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear. OBJECTIVES AND METHODS: We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009-2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. RESULTS: Porgression-free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70-79 years (P < 0.001). In contrast, 2-year cumulative relapse incidence, when accounting for non-relapse mortality as a competing risk, was no different between 70-79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS-G: 0-6 vs. >6) (P = 0.27). In 70-79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI <80% vs. ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70-79 years with an IDI <80% (vs. >80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32). CONCLUSION: 'R-mini-CHOP' provides adequate lymphoma-specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.
Authors: Stephen Booth; Hannah Plaschkes; Amy A Kirkwood; Adam Gibb; Patrick Horgan; Claire Higham; Joanna M Oladipo; Joe Browning; Usman Khan; Bing Tseu; Lucia Chen; John Willan; Julia Wolf; Arief Gunawan; Paul Fields; Tim Ebsworth; Robert Lown; Dominic Gordon-Walker; Nimish Shah; Kim M Linton; Graham P Collins; Jaimal Kothari; Catherine Hildyard; Toby A Eyre Journal: Blood Adv Date: 2020-09-22
Authors: Toby A Eyre; William Wilson; Amy A Kirkwood; Julia Wolf; Catherine Hildyard; Hannah Plaschkes; John Griffith; Paul Fields; Arief Gunawan; Rebecca Oliver; Stephen Booth; Jaimal Kothari; Christopher P Fox; Nicolas Martinez-Calle; Andrew McMillan; Mark Bishton; Graham P Collins; Chris S R Hatton Journal: Blood Adv Date: 2021-04-27
Authors: Tove Wästerlid; Kim Oren Gradel; Sandra Eloranta; Ingrid Glimelius; Tarec C El-Galaly; Henrik Frederiksen; Karin E Smedby Journal: Br J Haematol Date: 2020-11-24 Impact factor: 6.998
Authors: L Hounsome; T A Eyre; R Ireland; A Hodson; R Walewska; K Ardeshna; S Chaganti; P McKay; A Davies; C P Fox; N Kalakonda; P A Fields Journal: Br J Cancer Date: 2021-10-05 Impact factor: 7.640