Reduced-dose EPOCH-R chemotherapy for elderly patients with advanced stage diffuse large B cell lymphoma

The standard treatment in elderly patients with diffuse large B cell lymphoma (DLBCL) has not yet been finely established. We investigated the efficacy and safety of rituximab with a reduced-dose of EPOCH chemotherapy in elderly patients who had advanced DLBCL with high IPI scores. The dose of 70% E...

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Bibliographic Details
Published in:Annals of hematology 2018-10, Vol.97 (10), p.1809-1816
Main Authors: Zhang, Wen-Hao, Li, Gao-Yang, Ma, Yu-Jie, Li, Zhi-Chao, Zhu, Yang, Chang, Jun, Hao, Si-Guo, Tao, Rong
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Chemotherapy
Cyclophosphamide - administration & dosage
Cyclophosphamide - adverse effects
Disease Progression
Dose-Response Relationship, Drug
Doxorubicin - administration & dosage
Doxorubicin - adverse effects
Etoposide - administration & dosage
Etoposide - adverse effects
Female
Hematology
Humans
Lymphoma
Lymphoma, Large B-Cell, Diffuse - drug therapy
Lymphoma, Large B-Cell, Diffuse - mortality
Lymphoma, Large B-Cell, Diffuse - pathology
Male
Medical prognosis
Medicine
Medicine & Public Health
Monoclonal antibodies
Neoplasm Staging
Neutropenia
Oncology
Original Article
Prednisone - administration & dosage
Prednisone - adverse effects
Prognosis
Rituximab - administration & dosage
Rituximab - adverse effects
Targeted cancer therapy
Treatment Outcome
Vincristine - administration & dosage
Vincristine - adverse effects
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Summary:The standard treatment in elderly patients with diffuse large B cell lymphoma (DLBCL) has not yet been finely established. We investigated the efficacy and safety of rituximab with a reduced-dose of EPOCH chemotherapy in elderly patients who had advanced DLBCL with high IPI scores. The dose of 70% EPOCH was given to patients aged 75 to 79 years, and dose of 50% to patients aged over 80 years. Thirty-one patients with a median age of 79 years (range 75–86 years) were enrolled. Patients received a median of 6 cycle’s chemotherapy. The complete response rate was 71.0%. The 3-year overall survival (OS) and progression-free survival rates were 62.8 and 60.3%, respectively. The most frequent grade 3/4 adverse effects were neutropenia (3 patients, 7 events), febrile neutropenia (3 patients, 5 events), and pulmonary infection (3 patients, 3 events). Our study showed that ECOG score 3–4, bulky disease, β2-MG > 5.0 mg/L, and loss of any IADL are prognostic factors for OS in univariate analysis. In summary, reduced-dose EPOCH-R chemotherapy for very elderly patients is very effective with acceptable toxicities. Our preliminary study may provide an alternative approach to manage very elderly fit patients with advanced and poor risk DLBCL by first-line treatment with reduced-dose EPOCH-R.
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-018-3369-7