"Diffuse Large B-Cell Lymphoma in the Elderly: Real-World Outcomes From a Developing Country"

Area of Science:

• Oncology
• Hematology
• Clinical Pharmacology

Background:

• Elderly patients with Diffuse Large B-cell Lymphoma (DLBCL) require treatment balancing efficacy and toxicity.
• Anthracyclines, common in DLBCL treatment, pose risks of cardiotoxicity and myelosuppression in older adults.
• Non-anthracycline regimens are alternatives for elderly patients with cardiac issues or high anticipated toxicity.

Purpose of the Study:

• To compare treatment outcomes of R-CHOP versus R-CEOP in elderly DLBCL patients.
• To evaluate the efficacy and safety of anthracycline-based versus non-anthracycline regimens in this population.

Main Methods:

• Retrospective analysis of 218 DLBCL patients aged 60 years and above.
• Comparison of outcomes between patients receiving R-CHOP (n=71) and R-CEOP (n=137).
• Etoposide substituted for doxorubicin in R-CEOP based on physician discretion regarding patient factors and resources.

Main Results:

• R-CHOP demonstrated a significantly higher 2-year progression-free survival (PFS) rate (79.1%) than R-CEOP (49.6%, P < .001).
• R-CHOP superiority in PFS was observed in both early and advanced disease stages.
• Higher incidence of febrile neutropenia and grade III/IV hematological toxicities was noted with R-CHOP in the 60-65 age group.

Conclusions:

• Anthracycline-based regimens like R-CHOP should be considered for fit elderly DLBCL patients without cardiac contraindications, provided adequate supportive care is available.
• Treatment decisions should weigh the superior efficacy of R-CHOP against its increased toxicity profile in elderly individuals.