4335 - Diffuse large B cell lymphoma in the elderly. A retrospective analysis of standard versus alternative treatments

Background

Diffuse Large B cell lymphoma (DLBCL) is usually diagnosed between the 5th-6th decade of life. Its incidence increases with age. Chemotherapy (CT) with R-CHOP is the standard treatment for any age. However, in the clinical practice, alternative treatments with less toxicities are offered to elderly patients. This group of patients is usually not well represented in clinical trials. Our aim is to asses the benefit of standard treatment in this population, as well as discontinuation of treatment and its impact on overall survival (OS). As secondary endpoint, we have analyzed the survival rate in the subgroup of patients older than 75 years of age treated with CT.

Methods

A retrospective review was performed in patients ≥65 years who were diagnosed with DLBCL during the years 2013-2015 in the Hospital of Leon. Patients with histological confirmation of the primary diagnosis and who received treatment were included.

Results

65 patients were analyzed. The average age was 75 years. 64% were male and 30% had stage 4 disease at the time of diagnosis. The CT schemes were: R-CHOP (N = 28), R-CEOP (N = 11) and R-miniCHOP (N = 8). 10 patients had grade 4 AEs. One death ocurred after receiving the first cicle. 70% completed at least 4 cicles of CT. Median OS was 51 months versus (vs) 11 months in favor of R-CHOP group (HR = 0,59, p = 0,112 IC 95%=0,30-1,13). Results were not statistically significant likely because of the small sample size. 45% of patients had a complete response, 20% had a partial response and 10% had no response to treatment.The main cause of death was disease progression. Median OS was 15 months in both groups, in patients older than 75 treated with CT vs < 75 years of age. No statistically significant difference was seen, regardless of the treatment they received.

Conclusions

In clinical practice, age is an important variable to account for when deciding on the management approach for heamatological malignancies such as DLBCL. Although our results show a non-statistically significant benefit in OS of R-CHOP vs other schemes, this could be due to the small sample size. Given the prevalence of elderly population in our country, and the proved benefit of standard chemotherapy in the approach of DLBCL, more studies are needed.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.