In 2018 we report a rituximab plus nonpegylated liposomial doxorubicin (R-NPLD) combination for patients 80 years or older with diffuse B cell lymphoma (DLBCL) or grade 3 b follicular lymphoma. The overall 3-year survival, cause-specific survival and progression-free survival rates were 46%, 55%, and 44%, respectively. According to these results, R-NPLD has become the new standard treatment in patients > 80 years old with aggressive B lymphoma, in our institution. To better investigate the prognostic role of clinical and pathological factors, we analyzed the same combination in a larger cohort of patient 80 years or older with DLBCL.
We retrospectively and prospectively analyzed data of patients 80 years or older with untreated CD20-positive DLBCL. Patients received a combination treatment with rituximab plus nonpegylated liposomial doxorubicin. The regimen consisted of R 375 mg/sqm and NPLD 50 mg/sqm administered intravenously on cycle day 1, plus prednisone 50 mg orally on days 1 to 5, every 21 days for 6 courses.
Between May 2010 and April 2019, we enrolled 50 patients (median age 84, range 80-96). The median FU time was 28 months (range 10-104). The overall 3-years survival, cause-specific survival, and disease free survival rates were 49.9+7.6%,55.5+7.9%, and 48.5+7.8%. Treatment was well tolerated with mild toxicities, without treatment related hospitalization or toxic deaths. Patients achieving EFS12 and EFS18 had an overall 3-years survival of 66+13.0% and 67.9+7.0%, respectively.
Our results confirm that, in patients 80 years or older with DLBCL, R-NPDL is very effective and safe combination. Among prognostic factors, elevated LDH (> 1.25 upper limit) strongly correlates with overall survival and risk of relapse, in univariate (p=0.001, p=0.003) and multivariate (p=0.002, p=0.005) analysis. In patients who achieved EFS18 the probability to survive 24 and 36 months is of 90.5 and 67.9%, respectively, suggesting that EFS18 will be useful in patient counseling and should be considered as a robust end point for future studies of newly diagnosed very elderly DLBCL patients.
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