Oral Chemotherapy Application in Elderly Patients With Diffuse Large B-Cell Lymphoma: An Alternative Regimen in Retrospective Analysis

Pi-Han Liao; Ching-Yuan Kuo; Ming-Chun Ma; Chin-Kai Liao; Sung-Nan Pei; Ming-Chung Wang

doi:10.14740/jh1054

Oral Chemotherapy Application in Elderly Patients With Diffuse Large B-Cell Lymphoma: An Alternative Regimen in Retrospective Analysis

J Hematol. 2022 Oct;11(5):176-184. doi: 10.14740/jh1054. Epub 2022 Oct 31.

Authors

Pi-Han Liao¹, Ching-Yuan Kuo^{1

2}, Ming-Chun Ma¹, Chin-Kai Liao^{1

3}, Sung-Nan Pei^{1

3}, Ming-Chung Wang¹

Affiliations

¹ Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
² Kaohsiung Municipal Feng-Shan Hospital, Taiwan, Republic of China.
³ Department of Hematology, E-Da Cancer Hospital and I-Shou University, College of Medicine, Kaohsiung, Taiwan, Republic of China.

PMID: 36406829
PMCID: PMC9635798
DOI: 10.14740/jh1054

Abstract

Background: A combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is considered the standard treatment for diffuse large B-cell lymphoma (DLBCL). However, no standard treatment has been established for older patients (age ≥ 75 years). This study retrospectively analyzed different treatment strategies in older patients with DLBCL with different chemotherapy regimens and compared the survival rate of patients using oral or intravenous form cyclophosphamide and etoposide in a single center.

Methods: We reviewed the records of older patients with DLBCL, aged ≥ 75 years, from January 2010 to August 2019. The different treatment combinations, clinical characteristics, response rates, and toxicity profiles were analyzed. The median overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier (KM) method. Cox regression model was used to identify the risk factors.

Results: Eighty-four patients were included. One-quarter of the patients received cytoreduction treatment because of their poor medical condition at the time of diagnosis. Twenty-six percent of the patients were aged ≥ 85 at the time of diagnosis and 46.7% completed the treatment course. Patients receiving non-anthracycline-containing (non-ACR) treatment had worse Charlson comorbidity index, worse PFS, lower body mass index, or were older. The mean anthracycline accumulative dose in the anthracycline-containing (ACR) group was 134 mg/m². The median OS was 17.2 months and median PFS was 7.7 months. The PFS of R-CHOP is better than R-mini-CHOP and R-CVOP without statistical significance, but OS of R-CHOP is not better than the other regimens.

Conclusion: The toxicity, efficacy, and KM curve for OS and PFS in the non-ACR group were lower compared to ACR group, without statistical significance. R-CVOP had similar OS with R-mini-CHOP in our study. The result does not mean etoposide could totally substitute for anthracycline, but etoposide did have lower early progression rate (12.5%), and it may be an option for frail patients with comorbidity. Oral form cyclophosphamide and etoposide could be considered as a substitute for intravenous administration because of the similar effect and toxic profile.

Keywords: Anthracycline-free; DLBCL; Elderly; Etoposide; R-CHOP.