Diffuse large B-cell lymphoma in the elderly: diffusion of treatment with rituximab and survival advances with and without anthracyclines

Abstract Abstract 2693 Introduction: Treatment of Diffuse Large B-Cell Lymphoma (B-DLCL) is not well coded in the elderly patients. They may receive full dose immunochemotherapy, low dose chemotherapy or palliative treatment regarding co morbidities, Performans Status (PS), psychological, social or mental state. The lack of age-adapted prognosis factors including geriatric scales induce a subjective choice for the treatment. The purpose of the study is to evaluate the outcome of all the patients treated in a single institute for a B-DLCL, with comparison of age of diagnosis and treatment received. Methods: All patients with B-DLCL, age≥70 years, treated in the Paoli-Calmettes institute between 1995 and 2008 were included, excepted patients with intra-ocular and cerebral localizations or with a “Burkitt-like” histology. Were also excluded patients with incomplete data. Treatments were simplified for statistic analysis in three types: CHOP Like (CH-L): three chemotherapies with anthracyclin (or etoposide in place if cardiac impossibility) with conventional doses, mini-CHOP-Like (mCH-L): with reduce doses of anthracyclin and cyclophosphamide, or COP Like (C-L): two agents without anthracyclin. Factors studied in the different items are systematically Age (70–79 vs olders), PS (0–1 vs 2–4), LDH, Ann Arbor stage (AA:1–2 vs 3–4) and type of chemotherapy. Results: From 1995 to 2008, 212 patients with B-DLCL were admitted in the Paoli-Calmettes institute for a B-DLCL. The median age was 76 years [range 70–90], 70% of the patients had a PS=0–1 and 30% a PS=2–4, LDH was increased in 55% of patients, AA was 3–4 in 58% of cases. The repartition of chemotherapy was 56% for CH-L, 33% for mCH-L and 11% for C-L. In the 70–79 age subgroup, CH-L is predominant (67% vs 25% for the older patients, p<0.0001). Four patients died before therapy initiation. Survival curves for mCH-L and C-L are identical, with no difference of population characteristics and patients are grouped for the final analysis (mCH-CL group). Rituximab was added to the chemotherapy in 63% of cases. Overall Survival at 12 and 60 month was respectively 73% and 47% with a median [IC95] of 48.8 month. Age at diagnosis is statistically significant with a 5-year survival of 53% and 29% for respectively 70–79 years and older (p=0.0045). Patients characteristics of the age subgroups are different only for the type of chemotherapy infused (p<0.0001) and not for the others factors analyzed. Choice of chemotherapy was also important (P=0.0011) with an OS of 55% and 37% respectively for CH-L and mCH-CL protocols. In this case, patients characteristics are different in term of date of diagnosis (p<0.001), age of diagnosis (p<0.001), PS (0.04) and AA (0.011). Surprisingly, there is no difference in OS when rituximab was given (p=0.7), and despite the difference of treatment, there is no difference of incidence of relapse in the two age groups (p=0.97). Conclusion: Survival of our elderly population of patients with B-DLCL is comparable to the literature. With non-selected patients, repartition of factors from the IPI score is not different in the two age subgroups, but the more intensive chemotherapy is given in the less older patients. Moreover, OS is increased in this CH-L protocol, in contrast with the same incidence of relapse. Furthermore, the use of rituximab, a major treatment of B-DLCL in the elderly, do not influence OS in this non-selected population of patients. These data confirm the requirement of a more discriminant prognosis model than the IPI score for the daily practice, including relevant geriatric factors. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Efficacy Of Rituximab To Chemotherapy In The Treatment Of EBV-Positive Diffuse Large B-Cell Lymphoma

Blood ◽

10.1182/blood.v122.21.5120.5120 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5120-5120

Author(s):

Brady E Beltran ◽

Julio C Chavez ◽

Jorge J Castillo

Keyword(s):

Retrospective Study ◽

B Cell ◽

Cell Lymphoma ◽

Performance Status ◽

B Cell Lymphoma ◽

Response Rates ◽

The Elderly ◽

Female Ratio ◽

Large B Cell Lymphoma ◽

Large B Cell

Abstract Background EBV-positive diffuse large B-cell lymphoma (EBV+ DLBCL) of the elderly is a provisional entity included in the 2008 WHO Classification. EBV+ DLBCL of the elderly is characterized by an aggressive clinical course and a poor outcome. Furthermore, it is unclear if patients with EBV+ DLBCL of the elderly benefit from the addition of rituximab to chemotherapy. The goal of this retrospective study is to evaluate the clinical relevance of rituximab in this entity in a cohort of Peruvian patients. Methods Between January 2002 and December 2012, all patients meeting criteria for EBV+ DLBCL were included in the analysis. Patients with evidence of immunosuppression were excluded. All cases were positive for the presence of EBV-encoded RNA (EBER) by in situ hybridization, and CD20 and/or PAX-5 expression by immunohistochemistry. Clinical data were reviewed retrospectively and patients’ biopsies were evaluated for the immunohistochemical expression of BCL6, CD10, and MUM-1/IRF4. Overall survival (OS) was defined as the time between diagnosis and death or last follow-up. The Kaplan-Meiermethod was used to estimate OS curves, which were then comparedusing the log-rank test. P-values <0.05 were considered statistically significant. Results A total of 42 EBV+ DLBCL patients are included in this study. The median age at diagnosis was 73 years (range 25-95 years). The male-to-female ratio was 2.2:1. B symptoms were observed in 59%, a performance status ECOG >1 in 60%, advanced stage (III/IV) in 58%, and elevated LDH levels in 44% of the patients. Based on the Hans classification, 81% had a non-germinal center profile. The median Ki67 expression was 80% (range 50-90%). The Oyama score distribution, which uses age >70 and presence of B symptoms, was 0 factors 14%, 1 factor 45% and 2 factors in 40% of the patients. Based on the International Prognostic Index (IPI) score, 0-2 factors were seen in 39% and 3-5 in 61% of the patients. Chemotherapy was not administered in 9 patients due to poor performance status. R-chemotherapy was administered in 17 patients (52%) and chemotherapy without rituximab in 16 patients (48%). The overall response rate (ORR) was 52%, with complete response (CR) in 42%, partial response (PR) in 9% and no response (NR) in 48%. The response rates in patients who received chemotherapy without rituximab were: CR 37.5%, PR 0%, and NR 62.5%. Response rates in patients who received R-chemotherapy were: CR 47%, PR 17%, and NR 35%. The odds ratio for a CR was 2.48 (95% CI 0.49-13.2; p=0.21) for patients receiving R-chemotherapy when compared with patients who received chemotherapy alone. The median OS for treated patients was 8 months with a 3-year OS of 40%. For patients receiving R-chemotherapy, the median OS was 20 months with a 3-year OS of 47% and for patients receiving chemotherapy without rituximab, the median OS was 5 months with a 3-year OS of 37.5% (log-rank p=0.12). The median OS in patients 60 and older was significantly superior with R-chemotherapy in comparison with chemotherapy alone (20 vs. 1.5 months, log-rank p=0.02) Conclusions Based on the results of our retrospective study, the addition of rituximab to chemotherapy show a statistical trend towards improved survival rates versus chemotherapy alone in our cohort of patients with EBV+ DLBCL. In a subset analysis, the addition of rituximab to chemotherapy showed a survival benefit in our cohort of EBV+ DLBCL patients 60 years of age and older . Disclosures: No relevant conflicts of interest to declare.

Download Full-text