Stratified therapeutic choices in elderly patients with diffuse large B-cell lymphoma

doi:10.3760/cma.j.cn371439-20200814-00061

Abstract

Abstract:

The prognosis of elderly (>60 years) patients with diffuse large B-cell lymphoma (DLBCL) is significantly worse compared with young patients, and there is currently no standard treatment. Elderly patients with DLBCL are highly heterogeneous, a stratification before treatment can help achieve precise medicine and improve outcome of them. R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone) is still the recommended treatment for fit elderly DLBCL patients; and for unfit or very old patients, chemotherapy of reduced dose or palliative treatments should be considered. Choices for relapsed or refractory patients are limited, and novel compounds or therapies that are well tolerated may have a good application prospect.

Key words: Diffuse large B-cell lymphoma, Elderly patients, Treatment

Li Qiao'er, Zou Liqun. Stratified therapeutic choices in elderly patients with diffuse large B-cell lymphoma[J]. Journal of International Oncology, 2021, 48(5): 317-320.

References 26

[1]	Alvarez R, Esteves S, Chacim S, et al. What determines therapeutic choices for elderly patients with DLBCL? Clinical findings of a multicenter study in Portugal[J]. Clin Lymphoma Myeloma Leuk, 2014,14(5):370-379. DOI: 10.1016/j.clml.2014.01.008. doi: 10.1016/j.clml.2014.01.008 pmid: 24629852
[2]	Pfreundschuh M, Kuhnt E, Trümper L, et al. CHOP-like chemothe-rapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group[J]. Lancet Oncol, 2011,12(11):1013-1022. DOI: 10.1016/S1470-2045(11)70235-2. doi: 10.1016/S1470-2045(11)70235-2
[3]	Feugier P, Van Hoof A, Sebban C, et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte[J]. J Clin Oncol, 2005,23(18):4117-4126. DOI: 10.1200/JCO.2005.09.131. pmid: 15867204
[4]	Bai JF, Han HX, Feng R, et al. Comprehensive geriatric assessment (CGA): a simple tool for guiding the treatment of older adults with diffuse large B-cell lymphoma in China[J]. Oncologist, 2020,25(8):e1202-e1208. DOI: 10.1634/theoncologist.2019-0738.
[5]	Olivieri A, Gini G, Bocci C, et al. Tailored therapy in an unselected population of 91 elderly patients with DLBCL prospectively evaluated using a simplified CGA[J]. Oncologist, 2012,17(5):663-672. DOI: 10.1634/theoncologist.2011-0355. doi: 10.1634/theoncologist.2011-0355 pmid: 22531362
[6]	Coiffier B, Thieblemont C, Van Den Neste E, et al. Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Groupe d'Etudes des Lymphomes de l'Adulte[J]. Blood, 2010,116(12):2040-2045. DOI: 10.1182/blood-2010-03-276246.
[7]	Kühnl A, Cunningham D, Counsell N, et al. Outcome of elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: results from the UK NCRI R-CHOP14v21 trial with combined analysis of molecular characteristics with the DSHNHL RICOVER-60 trial[J]. Ann Oncol, 2017,28(7):1540-1546. DOI: 10.1093/annonc/mdx128. doi: 10.1093/annonc/mdx128
[8]	Wästerlid T, Biccler JL, Brown PN, et al. Six cycles of R-CHOP-21 are not inferior to eight cycles for treatment of diffuse large B-cell lymphoma: a Nordic Lymphoma Group Population-based Study[J]. Ann Oncol, 2018,29(8):1882-1883. DOI: 10.1093/annonc/mdy184. doi: 10.1093/annonc/mdy184
[9]	Pfreundschuh M, Murawski N, Zeynalova S, et al. Optimization of rituximab for the treatment of DLBCL: increasing the dose for elderly male patients[J]. Br J Haematol, 2017,179(3):410-420. DOI: 10.1111/bjh.14860. doi: 10.1111/bjh.14860
[10]	Odejide OO, Cronin AM, Davidoff AJ, et al. Limited stage diffuse large B-cell lymphoma: comparative effectiveness of treatment strategies in a large cohort of elderly patients[J]. Leuk Lymphoma, 2015,56(3):716-724. DOI: 10.3109/10428194.2014.930853. doi: 10.3109/10428194.2014.930853
[11]	Guidez S, Lacotte-Thierry L, Tomowiak C, et al. Oral CHOP-like chemotherapy in 60-80 years-old patients with diffuse large B-cell lymphoma[J]. Br J Haematol, 2019,186(6):e175-e178. DOI: 10.1111/bjh.16056.
[12]	Vitolo U, Chiappella A, Franceschetti S, et al. Lenalidomide plus R-CHOP21 in elderly patients with untreated diffuse large B-cell lymphoma: results of the REAL07 open-label, multicentre, phase 2 trial[J]. Lancet Oncol, 2014,15(7):730-737. DOI: 10.1016/S1470-2045(14)70191-3. doi: 10.1016/S1470-2045(14)70191-3
[13]	Peyrade F, Jardin F, Thieblemont C, et al. Attenuated immunochemotherapy regimen (R-miniCHOP) in elderly patients older than 80 years with diffuse large B-cell lymphoma: a multicentre, single-arm, phase 2 trial[J]. Lancet Oncol, 2011,12(5):460-468. DOI: 10.1016/S1470-2045(11)70069-9. doi: 10.1016/S1470-2045(11)70069-9
[14]	Park S, Jo JC, Do YR, et al. Multicenter phase 2 study of reduced-dose CHOP chemotherapy combined with rituximab for elderly patients with diffuse large B-cell lymphoma[J]. Clin Lymphoma Myeloma Leuk, 2019,19(3):149-156. DOI: 10.1016/j.clml.2018.11.003. doi: 10.1016/j.clml.2018.11.003
[15]	Eyre TA, Martinez-Calle N, Hildyard C, et al. Impact of intended and relative dose intensity of R-CHOP in a large, consecutive cohort of elderly diffuse large B-cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age[J]. J Intern Med, 2019,285(6):681-692. DOI: 10.1111/joim.12889. doi: 10.1111/joim.12889
[16]	Ha H, Keam B, Kim TM, et al. Reduced dose intensities of doxorubicin in elderly patients with DLBCL in rituximab era[J]. Cancer Res Treat, 2016,48(1):304-311. DOI: 10.4143/crt.2014.339. doi: 10.4143/crt.2014.339
[17]	Luminari S, Viel E, Ferreri AJM, et al. Nonpegylated liposomal doxorubicin combination regimen in patients with diffuse large B-cell lymphoma and cardiac comorbidity. Results of the HEART01 phase Ⅱ trial conducted by the Fondazione Italiana Linfomi[J]. Hematol Oncol, 2018,36(1):68-75. DOI: 10.1002/hon.2425. doi: 10.1002/hon.2425 pmid: 28524259
[18]	Storti S, Spina M, Pesce EA, et al. Rituximab plus bendamustine as front-line treatment in frail elderly (>70 years) patients with diffuse large B-cell non-Hodgkin lymphoma: a phase Ⅱ multicenter study of the Fondazione Italiana Linfomi[J]. Haematologica, 2018,103(8):1345-1350. DOI: 10.3324/haematol.2017.186569. doi: 10.3324/haematol.2017.186569
[19]	Zeremski V, Jentsch-Ullrich K, Kahl C, et al. Is bendamustine-rituximab a reasonable treatment in selected older patients with diffuse large B cell lymphoma? Results from a multicentre, retrospective study[J]. Ann Hematol, 2019,98(12):2729-2737. DOI: 10.1007/s00277-019-03819-3. doi: 10.1007/s00277-019-03819-3
[20]	Shen QD, Zhu HY, Wang L, et al. Gemcitabine-oxaliplatin plus rituximab (R-GemOx) as first-line treatment in elderly patients with diffuse large B-cell lymphoma: a single-arm, open-label, phase 2 trial[J]. Lancet Haematol, 2018,5(6):e261-e269. DOI: 10.1016/S2352-3026(18)30054-1. doi: 10.1016/S2352-3026(18)30054-1
[21]	Pfreundschuh M, Trümper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL[J]. Blood, 2004,104(3):634-641. DOI: 10.1182/blood-2003-06-2095. pmid: 15016643
[22]	Pfreundschuh M. How I treat elderly patients with diffuse large B-cell lymphoma[J]. Blood, 2010,116(24):5103-5110. DOI: 10.1182/blood-2010-07-259333. doi: 10.1182/blood-2010-07-259333 pmid: 20805363
[23]	Arcari A, Chiappella A, Spina M, et al. Safety and efficacy of ritu-ximab plus bendamustine in relapsed or refractory diffuse large B-cell lymphoma patients: an Italian retrospective multicenter study[J]. Leuk Lymphoma, 2016,57(8):1823-1830. DOI: 10.3109/10428194.2015.1106536. doi: 10.3109/10428194.2015.1106536
[24]	Djebbari F, Browning JA, Stanton L, et al. Efficacy of R-GCVP in patients with late relapse of diffuse large B-cell lymphoma[J]. Br J Haematol, 2019,186(6):e191-e195. DOI: 10.1111/bjh.16071.
[25]	Shingleton JR, Dave SS. Polatuzumab vedotin: honing in on relapsed or refractory diffuse large B-cell lymphoma[J]. J Clin Oncol, 2020,38(2):166-168. DOI: 10.1200/JCO.19.02587.
[26]	Schuster SJ, Bishop MR, Tam CS, et al. Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma[J]. N Engl J Med, 2019,380(1):45-56. DOI: 10.1056/NEJMoa1804980. doi: 10.1056/NEJMoa1804980