A Retrospective Analysis of Real-World Outcomes of Elderly Chinese Patients with Diffuse Large B-Cell Lymphoma
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma, with its incidence increasing significantly with age. Approximately two-thirds of DLBCL cases occur in patients older than 65 years, and the median age at diagnosis is between 70 and 75 years. Elderly patients with DLBCL often have a worse prognosis compared to younger patients, primarily due to poorer tolerance to full-dose therapies and the presence of comorbidities. As a result, older age (over 60 years) has been recognized as an adverse prognostic factor in the International Prognostic Index (IPI) for predicting survival in DLBCL patients. The optimal treatment strategy for elderly patients with DLBCL remains controversial, and this study aims to investigate the clinical features and outcomes of elderly Chinese patients with DLBCL, focusing on the impact of clinical and molecular factors on survival.
The study conducted a retrospective analysis of 349 elderly patients (aged over 60 years) diagnosed with DLBCL at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College between April 2006 and December 2012. Patients were divided into two age groups: 61–69 years and 70 years or older. The clinical characteristics, treatment regimens, and outcomes of these patients were compared between the two groups.
The median age of the patients was 68 years, with a range of 61 to 92 years. Among the 349 patients, 204 (58.5%) were aged 61 to 69 years, and 145 (41.5%) were aged 70 years or older. The male-to-female ratio was 1.14, indicating a slightly higher prevalence of DLBCL in men. The clinical characteristics of the two age groups were comparable, except for the Eastern Cooperative Oncology Group (ECOG) performance status, where more patients aged 70 years or older had an ECOG PS of 2 or higher (P < 0.001).
The treatment regimens varied among the patients. Most patients (59.9%) received initial treatment with chemotherapy alone, followed by chemoradiotherapy (32.7%), surgery plus chemoradiotherapy (4.3%), and other treatments or no treatment (3.2%). The addition of rituximab to chemotherapy occurred in 199 patients (57.0%). There was no significant difference in the use of rituximab between the two age groups, with 59.3% of patients aged 61–69 years and 53.8% of patients aged 70 years or older receiving chemotherapy plus rituximab.
The study’s primary endpoints were overall survival (OS) and progression-free survival (PFS). OS was defined as the interval between the date of initial treatment and the date of death from any cause or the date of the last follow-up. PFS was defined as the interval from the date of first treatment to the date of disease progression, recurrence, or death due to any cause. With a median follow-up of 82 months (range: 1–129 months), the 5-year OS and PFS rates for the entire cohort were 51.9% and 45.8%, respectively. The 5-year OS rates for patients aged 61–69 years and those aged 70 years or older were 58.3% and 42.8% (P = 0.007), respectively, while the 5-year PFS rates were 51.0% and 38.6% (P = 0.034), respectively.
The study found that treatment regimens including rituximab significantly improved survival outcomes. For the overall population, the 5-year OS rate was 63.1% for patients who received rituximab-based therapy compared to 37.1% for those who received chemotherapy alone (P < 0.001). Similarly, the 5-year PFS rate was 56.6% for rituximab-based therapy versus 31.8% for chemotherapy alone (P < 0.001). These survival benefits were observed in both age groups. For patients aged 61–69 years, the 5-year OS rate was 66.7% for rituximab-based therapy compared to 46.4% for chemotherapy alone (P = 0.002), and the 5-year PFS rate was 60.0% versus 38.1% (P = 0.002). For patients aged 70 years or older, the 5-year OS rate was 57.7% for rituximab-based therapy compared to 25.4% for chemotherapy alone (P < 0.001), and the 5-year PFS rate was 51.3% versus 23.9% (P < 0.001).
Multivariate analysis identified several independent risk factors for poorer survival outcomes in elderly patients with DLBCL. For 5-year OS, advanced disease stage (Ann Arbor stage III/IV), elevated lactate dehydrogenase (LDH) levels, initial treatment, and chemotherapy without rituximab were significant predictors. For 5-year PFS, advanced disease stage, elevated LDH levels, and chemotherapy without rituximab were independent risk factors.
The study’s findings highlight the importance of rituximab-based immunochemotherapy in improving survival outcomes for elderly patients with DLBCL, regardless of age. The R-CHOP-like regimen, which includes rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, should be considered for elderly patients, even those aged 70 years or older. However, treating elderly patients requires careful evaluation of toxicities throughout the treatment process. A comprehensive geriatric assessment (CGA) or a similar evaluation tool may be necessary to optimize treatment recommendations and improve outcomes for this population.
In conclusion, this study provides valuable insights into the clinical characteristics and outcomes of elderly Chinese patients with DLBCL. The results demonstrate that elderly patients aged 70 years or older have poorer survival outcomes compared to those aged 61–69 years. However, rituximab-based immunochemotherapy significantly improves survival in both age groups, underscoring the importance of incorporating rituximab into the treatment regimen for elderly patients with DLBCL. Future studies should focus on optimizing treatment strategies for elderly patients, particularly those with comorbidities and poor performance status, to further improve survival and quality of life.
doi.org/10.1097/CM9.0000000000000354
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