Diffuse large B cell lymphoma in the elderly - an Indian perspective

Aim/Background

Diffuse Large B-Cell Lymphoma (DLBCL) is the most frequent Non Hodgkin's Lymphoma in elderly. With rising number of elderly (aged ≥60 yrs), it is important to study patterns of this disease, data being scarce in Indian settings. The aim of this study was to document presentations of DLBCL among the elderly and their outcome at a tertiary care oncology centre in India.

Methods

A retrospective record review, from 2007 to 2014, of 119 DLBCL cases aged ≥ 60 years, was done at the Kidwai Memorial Institute of Oncology, India. Demography, clinical features, investigations and treatment details were analyzed.

Results

The mean age of the 119 elderly was 69.54 yrs (± 5.44; 60–84 yrs) with male: female ratio of 1.52:1. B symptoms were seen in 33% patients. 36% of the patients had stage II disease. Advanced stage with more than one EN site (Ann Arbor IV) was seen in 12% and bulky disease in 9.5%. Bone marrow was involved in 12%. The common extranodal site was the head and neck region, followed by gastrointestinal tract. ECOG PS was 2 or more in 27.7% and 56.3% presented with high serum LDH levels. CD20 was positive in all 119 cases. 31.93% and 44.54% of cases were low and low intermediate risk respectively by IPI scoring. Of the 119 patients, 98 (64.7%) received treatment (minimum 3 cycles) with combination of either rituximab, cyclophosphamide, adriamycin, vincristine & prednisolone. The various treatment regimens were R-CHOP (15 pts), R-COP (2 pts), CHOP (58 pts), COP (11 pts), CEOP (6 pts) or chlorambucil /prednisolone (6 pts). 21 patients received only best supportive care. 8 (8.16%) patients received local radiotherapy. 9 (9.18%) patients had some mode of surgery. Overall response rate was seen in 62 patients (63.26%) with complete response in 38 (38.77%). 49 patients were alive with no disease, 8 were alive with disease, 2 died and 39 patients lost to follow-up. Relapse was seen in 5 patients (5.1%). The OS ranged from 2 to 123 months (median of 9.5 months). Among the clinico-pathological factors, bulky disease (P −0.034) and high IPI score was associated with statistically significant poor survival.

Conclusions

DLBCL in the Indian elderly population has a good response to treatment, however several cases default treatment leading to adverse outcomes.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.