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R-miniCHOP versus R-CHOP in elderly patients with diffuse large B-cell lymphoma: A propensity matched

D Al-Sarayfi1, M Brink2, M E D Chamuleau3

  • 1Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands.

American Journal of Hematology
|November 28, 2023
PubMed
Summary
This summary is machine-generated.

For frail elderly patients with diffuse large B-cell lymphoma (DLBCL), R-miniCHOP offers a tolerable treatment. However, survival outcomes like progression-free survival and overall survival were inferior compared to R-CHOP, necessitating careful patient selection.

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Area of Science:

  • Oncology
  • Hematology
  • Clinical Medicine

Background:

  • Diffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin lymphoma.
  • Elderly and frail patients often require modified treatment strategies due to comorbidities and reduced tolerance to intensive chemotherapy.
  • R-miniCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) was introduced as a less intensive option for frail elderly DLBCL patients.

Purpose of the Study:

  • To compare the survival outcomes of elderly DLBCL patients treated with R-miniCHOP versus standard R-CHOP.
  • To assess the effectiveness and safety of R-miniCHOP in a real-world setting.

Main Methods:

  • Retrospective analysis of DLBCL patients aged 65 years and older diagnosed between 2014-2020 in the Netherlands.
  • Propensity-score matching was used to compare patients treated with R-miniCHOP (n=384) and R-CHOP (n=384).
  • Primary endpoints included progression-free survival (PFS), overall survival (OS), and relative survival (RS), with follow-up through 2022.

Main Results:

  • The use of R-miniCHOP increased from 2% in 2014 to 15% in 2020.
  • Patients treated with R-miniCHOP had significantly inferior 2-year PFS (51% vs. 68%), OS (60% vs. 75%), and RS (69% vs. 86%) compared to R-CHOP.
  • Multivariable analysis showed a higher risk of all-cause mortality (HR 1.73) for patients receiving R-miniCHOP.

Conclusions:

  • While R-miniCHOP is an effective option for many elderly DLBCL patients, it is associated with inferior survival outcomes compared to R-CHOP.
  • The increasing use of R-miniCHOP highlights the need for careful consideration of individual patient fitness when selecting initial treatment for DLBCL.