Autologous Stem Cell Transplantation (ASCT) for Elderly Patients (≥ 60 Years) with Non-Hodgkin’s Lymphoma (NHL): An Analysis Based on EBMT Registry.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1888-1888
Author(s):  
Esa Jantunen ◽  
Carmen Canals ◽  
Didier Blaise ◽  
Alessandro Rambaldi ◽  
Herve Tilly ◽  
...  
Keyword(s):  
Stem Cell ◽  
Elderly Patients ◽  
Performance Status ◽  
Poor Performance ◽  
B Cell Lymphoma ◽  
Poor Performance Status ◽  
Significant Prognostic Factor ◽  
Bulky Disease ◽  
Stem Cell Source ◽  
Mantle Cell

Abstract Limited data is available on feasibility and efficacy of ASCT in elderly patients with NHL. Patients: In 2000–2005 15869 NHL patients with ASCT were reported to EBMT database, 3133 (20%) were ≥ 60 years. Only patients with MED-B dataset and those with either diffuse large B-cell lymphoma (DLBCL), mantle cell (MCL) or follicular lymphoma (FL) were subjected to more detailed analysis. This group included 906 elderly NHL patients (median age 63 years, range 60–75) (DLBCL, n = 463; MCL, n = 208; FL, n = 235) who were compared with 3661 patients < 60 years (DLBCL, n = 2149; MCL, n = 435; FL, n = 1077) regarding outcome. Bulky disease was more common in younger patients (26% vs. 15%, p < 0.001) as well as B-symptoms at diagnosis (42% vs. 36%, p = 0.02). Elderly patients had received more often at least two treatment lines before ASCT (70% vs. 59%, p<0.001). The median follow-up for the surviving patients was 14 months. Results: Non-relapse mortality (NRM) was higher in patients ≥ 60 years of age: 3.8% vs.2.3% at 100 days, 6.9% vs. 3.9% at 1 year and 9.4% vs. 5.8% at 3 years (p<0.001). No differences in NRM were observed between patients aged 60–64 years (n = 633) and those aged 65–69 (n = 240). A higher NRM was observed in DLBCL and MCL patients compared to FL patients (p=0.001and p=0.002, respectively). Other variables associated with a higher NRM were an elevated LDH at diagnosis (p=0.04), ≥ 2 treatment lines before ASCT (p<0.001); a poor performance status at ASCT (p<0.001); not being in CR1 at ASCT (chemosensitive disease vs. CR1, p=0.02; chemorefractory disease vs. CR1, p<0.001) and BM as stem cell source (p=0.02). In multivariate analysis, elderly patients showed a higher NRM [RR = 1.6 (CI 1.2–2.1), p=0.001]. In patients with DLBCL, age ≥ 60 years at ASCT was associated with a trend to a higher risk of relapse or progression (p =0.07) and a worse PFS (p=0.008). PFS at 2 years was 69% vs. 79% for patients in CR1 and 52% vs. 60% for patients with sensitive disease at ASCT, respectively. In MCL, elderly patients had worse PFS (p=0.008). PFS at 2 years was 78 vs. 81% for MCL patients in CR1 and 52% vs. 67%, respectively for those patients autografted with sensitive disease. Older age was not a significant prognostic factor either for relapse rate or for PFS in patients with FL. PFS at 2 years was 69% and 81% for FL patients in CR1, and 69% and 69% for FL patients with sensitive disease, respectively. Conclusions: ASCT is feasible in selected NHL patients aged 60–69 years. The outcome is promising taking into account the generally poorer prognosis of lymphomas in elderly population.

scholarly journals Disease Characteristics, Patterns of Care, and Survival in Very Elderly Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4480-4480
Author(s):  
Jessica N. Williams ◽  
Ashish Rai ◽  
Joseph Lipscomb ◽  
Jean L. Koff ◽  
Loretta J. Nastoupil ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Performance Status ◽  
Poor Performance ◽  
B Cell Lymphoma ◽  
Stage Iii ◽  
Poor Performance Status ◽  
Very Elderly ◽  
Selection Factors ◽  
The Impact ◽  
To Receive

Abstract Context: Despite having the highest incidence of diffuse large B-cell lymphoma (DLBCL), individuals older than 80 years are rarely included in DLBCL clinical trials or epidemiological studies. We sought to better characterize DLBCL presentation, treatment, and survival patterns for this age group. Objective: We investigated demographic and clinical characteristics at diagnosis, treatment selection factors, and the impact of treatment regimen on overall survival (OS) and lymphoma-related survival (LRS) for DLBCL patients >80 years. We hypothesized that patients >80 years were more likely to undergo observation and less likely to receive standard-of-care rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). We also hypothesized that patients >80 years who received R-CHOP would have superior OS and LRS, even after controlling for demographic and clinical factors. Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to examine DLBCL patients diagnosed from 1999-2009 and followed through 2010. Our population-based cohort contained 5,924 DLBCL patients aged ≥66 years; 1,422 were >80 years. Only patients treated within 6 months of diagnosis with R-CHOP; cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP); cyclophosphamide, vincristine, and prednisone (CVP); rituximab plus CVP (R-CVP); or patients undergoing observation were included in order to examine factors associated with the use of anthracyclines. Chi-squared tests compared characteristics and initial treatments of DLBCL patients >80 years and 66-80 years. Multivariable logistic regression models examined treatment selection factors in patients >80 years. Standard and propensity score-adjusted multivariable Cox proportional hazards models adjusted for patient demographics, clinical characteristics, comorbidities, performance status, and year of diagnosis examined relationships between treatment regimen, treatment duration, and survival. Results: Among patients >80 years, 58% were female, 91% were Caucasian, 36% had stage III/IV disease, 39% had extranodal involvement, 7% had B-symptoms, 28% had poor performance status, and 14% had ≥2 comorbidities. Patients >80 years were less likely to receive R-CHOP (43% vs. 61%) and more likely to be observed (30% vs. 15%) or receive R-CVP (12% vs. 4%); all p<0.0001. Sex, marital status, area-level poverty, year of diagnosis, performance status, and disease site were associated with R-CHOP treatment in patients >80 years. The initial receipt of R-CHOP was more commonly associated with female sex (odds ratio (OR) 1.31, 95% confidence interval 1.01-1.71), being married (OR 1.69, 1.07-2.66) and a diagnosis after 2001 (OR for 2002 11.71, 6.32-21.70; persistently increased ORs thereafter). The initial receipt of R-CHOP was less commonly associated with extranodal disease (OR 0.71, 0.55-0.91), poor performance status (OR 0.57, 0.44-0.75), and residence in a census tract with >12% of residents living in poverty (OR 0.69, 0.50-0.96). Initial observation was more commonly associated with the same factors that were less commonly associated with R-CHOP use and was less commonly associated with stage III/IV disease (OR 0.66, 0.50-0.87). Kaplan-Meier survival curves revealed that in patients >80 years, R-CHOP was associated with the best OS and LRS. Multivariable Cox proportional hazards models revealed that R-CHOP for >4 cycles was associated with the best OS in patients >80 years of all stages (hazard ratio (HR) 0.48, 0.37-0.62). Among stage III/IV patients, R-CHOP for >4 cycles (HR 0.48, 0.31-0.72) and R-CVP for >4 cycles (HR 0.40, 0.21-0.76) demonstrated significantly longer OS. Conclusions:Although DLBCL patients >80 years were less likely to receive R-CHOP, this regimen conferred the best survival. The failure of very elderly DLBCL patients to receive R-CHOP may occur due to clinical factors such as poor performance status, but commonly varies across demographic factors such as area-level poverty, which may reflect bias in the under-utilization of R-CHOP in very elderly patients that is not based on clinical parameters. Further studies are needed to characterize the impact of DLBCL treatment on quality of life in very elderly patients, and algorithms should be developed to help guide therapy in this population. Disclosures No relevant conflicts of interest to declare.

scholarly journals Poor Prognosis of Diffuse Large B-Cell Lymphoma with Hepatitis C Infection

2021 ◽  
Vol 11 (9) ◽  
pp. 844
Author(s):  
Yu-Fen Tsai ◽  
Yi-Chang Liu ◽  
Ching-I Yang ◽  
Tzer-Ming Chuang ◽  
Ya-Lun Ke ◽  
...  
Keyword(s):  
Hepatitis C ◽  
B Cell ◽  
Cell Lymphoma ◽  
Performance Status ◽  
Poor Performance ◽  
B Cell Lymphoma ◽  
Liver Involvement ◽  
Poor Performance Status ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Background: Hepatitis C virus (HCV) in diffuse large B-cell lymphoma (DLBCL) is associated with a higher prevalence and distinctive clinical characteristics and outcomes. Methods: A retrospective analysis of adult DLBCL patients from 2011 to 2015 was studied. Results: A total of 206 adult DLBCL were enrolled with 22 (10.7%) HCV-positive patients. Compared to HCV-negative patients, the HCV-positive group had a poor performance status (p = 0.011), lower platelet count (p = 0.029), and higher spleen and liver involvement incidences (liver involvement, p = 0.027, spleen involvement, p = 0.026), and they received fewer cycles of chemotherapy significantly due to morbidity and mortality (p = 0.048). Overall survival was shorter in HCV-positive DLBCL (25.3 months in HCV-positive vs. not reached (NR), p = 0.049). With multivariate analysis, poor performance status (p < 0.001), advanced stage (p < 0.001), less chemotherapy cycles (p < 0.001), and the presence of liver toxicity (p = 0.001) contributed to poor OS in DLBCL. Among HCV-positive DLBCL, the severity of liver fibrosis was the main risk factor related to death. Conclusion: Inferior survival of HCV-positive DLBCL was observed and associated with poor performance status, higher numbers of complications, and intolerance of treatment, leading to fewer therapy. Therefore, anti-HCV therapy, such as direct-acting antiviral agents, might benefit these patients in the future.

scholarly journals Efficacy of metronomic vinorelbine in elderly patients with advanced non-small-cell lung cancer and poor performance status

2017 ◽  
Vol 24 (3) ◽  
pp. 199 ◽  
Author(s):  
C. Bilir ◽  
S. Durak ◽  
B. Kızılkaya ◽  
I. Hacıbekiroglu ◽  
E. Nayır ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Survival Rate ◽  
Elderly Patients ◽  
Performance Status ◽  
Poor Performance ◽  
Small Cell ◽  
Survival Duration ◽  
Poor Performance Status ◽  
Small Cell Lung ◽  
Metronomic Vinorelbine

Background Metronomic chemotherapy—administration of low-dose chemotherapy—allows for a prolonged treatment duration and minimizes toxicity for unfit patients diagnosed with advanced non-small-cell lung cancer (nsclc).Methods Oral metronomic vinorelbine at 30 mg thrice weekly was given to 35 chemotherapy-naive patients who were elderly and vulnerable to toxicity and who had been diagnosed with advanced nsclc.Results Median age in this male-predominant cohort (29:6) was 76 years (range: 65–86 years). Histology was squamous cell carcinoma in 21 patients and adenocarcinoma in 14. There were no complete responses and 9 partial responses, for an overall response rate of 26%. Stable disease was seen in 15 patients (43%), and 11 patients (31%) had progressive disease. The 1-year survival rate was 34%, and the 2-year survival rate was 8%. The survival analysis showed a median progression-free survival duration of 4 months (range: 2–15 months) and an overall survival duration of 7 months (range: 3–24 months).Conclusions Metronomic vinorelbine had an acceptable efficacy and safety profile in elderly patients with multiple comorbidities who had been diagnosed with advanced nsclc. Metronomic vinorelbine could be a treatment option for elderly patients with poor performance status who are unfit for platinum-based chemotherapy and intravenous single-agent chemotherapy, and who are not candidates for combination modalities.

scholarly journals Outcome and Determinants of Failure to Complete 6-8 Cycles of Primary R-CHOP Treatment for Reasons Unrelated to Progression Among Patients with Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4200-4200
Author(s):  
Karin Ekstrom Smedby ◽  
Sara Harrysson ◽  
Per-Ola Andersson ◽  
Gunilla Enblad ◽  
Sara Ekberg ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Old Age ◽  
Performance Status ◽  
Poor Performance ◽  
B Cell Lymphoma ◽  
Primary Treatment ◽  
Poor Performance Status ◽  
Large B Cell Lymphoma ◽  
Kaplan Meier ◽  
Extranodal Disease

Abstract Purpose: A few patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who start on standard primary treatment with R-CHOP do not complete the recommended 6-8 cycles for reasons related to toxicity, however, this group has seldom been formally studied. We set out to describe the outcome of DLBCL patients failing to complete at least 6 R-CHOP cycles for reasons other than non-response, and to investigate determinants of such failure. Methods: We identified patients diagnosed with DLBCL in Sweden 2007-2014 who started primary treatment with R-CHOP (i.e., received at least one cycle) with the aim to receive 6 or 8 cycles, in the national Swedish Lymphoma Register (N=2,155). The analysis covered 5 out of 6 health care regions (70% of all patients diagnosed nationally). Overall survival by number of cycles was estimated using Kaplan-Meier curves (with censoring at stable disease or progression at first interim evaluation to avoid inclusion of patients who switched therapy due to non-response). Univariable and multivariable logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI) for the association between baseline clinical and demographic characteristics and failure to complete full R-CHOP treatment (i.e., receipt of less than 6 cycles compared with 6 cycles or more). Baseline characteristics included age, sex, calendar period of diagnosis, performance status, Ann Arbor stage, serum-lactate dehydrogenase, hemoglobin level, number of extranodal disease locations, and international prognostic index (IPI) score. In the logistic regression analysis, patients with early tumor progression (stable or progressive disease at interim or final evaluation) were excluded. Results: Among the 2,155 patients who started on R-CHOP, 399 (18.5%) failed to complete 6 cycles. Of these, 137 patients (6.4%) received only 1 or 2 cycles, and 262 (12.2%) received between 3 and 5 cycles. Only 42 patients stopped prematurely due to evidence of non-response whereas the majority (357 out of 399 patients, 89%) did so for other reasons related to toxicity and early death. Patients who failed to complete 6 cycles were older than other patients (median age 77 versus 68 years), more often had a WHO performance status of 2 or more (33% versus 12%) and more often were diagnosed with stage IV disease (40% versus 33%). Number of received R-CHOP cycles strongly correlated with survival (Figure 1). Among patients 65 years of age or younger, 5-year OS varied from 18% (95% CI 4-42%) following <3 cycles, to 70% (95% CI 53-82%) following 3-5 cycles, and 95% (95% CI 93-97%) following at least 6 cycles. Among patients older than 65 years, the corresponding figures were 13% (7-21%), 44% (95% CI 36-52%) and 81% (95% CI 78-84%), respectively (Figure 1). Using logistic regression, old age, poor performance status, hemoglobin levels <100, >1 extranodal disease location and high IPI were statistically significantly associated with failure to complete at least 6 R-CHOP in univariable analysis. In a multivariable model, old age, poor performance status and >1 extranodal location remained significantly associated with failure to complete 6 cycles of R-CHOP for reasons other than non-response. Conclusion: A surprisingly large proportion of patients diagnosed with DLBCL intended for treatment with 6-8 R-CHOP cycles fail to complete the treatment at the population-based level for reasons unrelated to non-response. Failure to complete at least 6 R-CHOP cycles was associated with poor survival, especially for patients receiving 1-2 cycles only, but also for those receiving 3-5 cycles. Old age and poor performance status most strongly predicted such failure. Figure 1: Kaplan-Meier curve of overall survival of patients with DLBCL diagnosed in Sweden 2007-2014 by number of administered R-CHOP cycles overall (top panel) and by age at diagnosis above or below 65 years (bottom panels). Disclosures Ekstrom Smedby: Janssen Pharmaceuticals: Other: The Department have recieved partial funding from Janssen Pharmaceuticals. Harrysson:Janssen Pharmaceuticals: Other: The Department have recieved partial funding from Janssen Pharmaceuticals. Ekberg:Janssen Pharmaceuticals: Other: The department has received partial funding from Janssen Pharmaceuticals. Eloranta:Janssen Pharmaceuticals: Other: S Eloranta is currently employed as a project coordinator and her salary is funded via a public-private real world evidence collaboration between Karolinska Institutet and Janssen Pharmaceuticals.

scholarly journals No Prognostic Impact of p53 and P-Glycoprotein Expression in Patients with Diffuse Large B-Cell Lymphoma

ISRN Oncology ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6
Author(s):  
Pairaya Rujirojindakul ◽  
Kumpol Aiempanakit ◽  
Kanita Kayasut ◽  
Arnuparp Lekhakula ◽  
Hutcha Sriplung
Keyword(s):  
De Novo ◽  
Performance Status ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Poor Performance ◽  
B Cell Lymphoma ◽  
Poor Performance Status ◽  
Prognostic Impact ◽  
P Glycoprotein ◽  
Formalin Fixed Paraffin Embedded

The aim of this study was to determine the clinical significances of p53 and p-glycoprotein (P-gp) expression on outcome predictors for patients with DLBC. We assessed the immunohistochemical expression of p53 and P-gp using formalin-fixed, paraffin-embedded specimens in 108 patients diagnosed with de novo DLBC. A high expression of p53 was found in 53.7% of the patients. No expression of P-gp was demonstrated in any of the specimens. There were no significant differences in the complete remission (CR) rate (P=0.79), overall survival (OS) (P=0.73), or disease-free survival (DFS) (P=31) between the p53-positive and p53-negative groups. The final model from multivariate analysis that revealed poor performance status was significantly associated with CR (P<0.001) and OS (P<0.001). Moreover, the advanced stage was a significant predictor of DFS (P=0.03). This study demonstrated no impact of the expression of p53 on either response or survival rates.

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