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Leo I. Gordon, MD, FACP


Prognostic Model May Help to Identify Elderly Patients With DLBCL Suited for Chemotherapy

By: Julia Fiederlein
Posted: Tuesday, September 6, 2022

According to Katsuhiro Miura, MD, of the Nihon University School of Medicine, Tokyo, and colleagues, the risk-oriented, personalized Age, Comorbidity, Albumin (ACA) index conferred an “excellent” outcome among a population-based, nonselected cohort of elderly patients with diffuse large B-cell lymphoma (DLBCL). The results of this retrospective study, which were presented during the European Hematology Association (EHA) 2022 Congress (Abstract P1212), were favorable or comparable to those of major clinical trials employing one-size-fits-all strategies.

A total of 138 evaluable patients who were at least 65 years of age were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). The initial dose intensity was determined by the International Prognostic Index, the ACA Index, and organ function. Based on the ACA index, patients were categorized into excellent (n = 30), good (n = 45), moderate (n = 45), or poor (n = 18) groups.

In all patients, the treatment completion rate was 80%, and the 2-year overall survival rate was 76%. These rates were 97%, 89%, 69%, and 61% (P = .0009) and 95%, 84%, 67%, and 46% (P = .0003) in the excellent, good, moderate, and poor groups, respectively. Among the groups, the initial dose intensities, mean relative dose intensities, incidences of unplanned hospitalization, incidences of febrile neutropenia, and incidences of treatment-related mortality were 94%, 83%, 71%, and 66% (P < .0001), 89%, 75%, 59%, and 48% (P < .0001), 10%, 16%, 22%, and 44% (P = .03845), 7%, 9%, 16%, and 28% (P = .1712), and 0%, 0%, 2%, and 17% (P = .0155), respectively. An exploratory analysis of patients who were at least 80 years of age revealed a treatment completion rate of 72% and a 2-year overall survival rate of 69%. The mean initial dose intensity was 62%, and the mean relative dose intensity was 53%.

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