Outcome of DLBCL patients over 80 years: A retrospective survey from 4 Institutions

Transcription

1 Outcome of DLBCL patients over 80 years: A retrospective survey from 4 Institutions AA Moccia, S Gobba, A Conconi, S Diem, L Cascione, K Aprile von Hohenstaufen, W Gulden Sala, A Stathis, F Hitz, G Pinotti, G Gaidano, and E Zucca Oncology Institute of Southern Switzerland, Bellinzona, Switzerland Medical Oncology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy Hematology, University of Eastern Piedmont, Ospedale Maggiore della Carita, Novara, Italy Medical Oncology, Kantonsspital St. Gallen, Switzerland Partly presented at the 13th International Conference on Malignant Lymphoma, Lugano (Switzerland), June, 2015 [Moccia AA et al. Hematol Oncol (Suppl 1):212 (abs216)]

2 Introduction DLBCL is highly curable if properly treated (aggressively) information about very elderly patients (over 80 year old) is relatively scanty best management is controversial not included in prospective clinical trials simplified regimens may compromise the outcome a significant proportion does not carry co-morbidities and may tolerate standard treatment

3 Methods Retrospective analysis using the local databases of 4 Institutions in Switzerland and Northern Italy: All newly diagnosed DLBCL treated from 1981 to 2013 included Patients with HIV infection excluded Variety of regimens, chosen by the treating physician

4 Methods Clinical characteristics at diagnosis and the presence of co-morbidities (Charlson co-morbidity index) retrieved from the databases and clinical charts. Primary endpoints were: overall survival (OS), progression free survival after front-line treatment (PFS) cause specific survival (CSS)

5 Results We identified 281 pts who met the stated inclusion criteria median age 84 y (range 80-97)

6 Patients characteristics.1

7 Patients characteristics.2

8 Patients characteristics.3

9 Patients characteristics.4 Laboratory test N/tested % Haemoglobin <10 g/dl 37/ Lymphocytes >4.0 x109/l 4/ Lymphocytes <1.0 x109/l 41/ Albumin <36 g/l 112/ LDH >UNL 156/ LDH >3xUNL 14/ Βeta2-microglobulin>3.0 mg/l 78/ Creatinine >UNL (m>106,f>91µmol/l) 80/ GFR <60 ml/min/1.73m 2 92/ ASAT > normale 10/ ALAT > UNL 6/ Anti-HCV + 19/ HBsAg + 3/

10 Treatments N % Corticosteroids only 14 5 Radiation therapy or surgery alone Chemotherapy without anthracyclines CHOP or CHOP-like chemotherapy Rituximab conteining regimens

11 Treatment response (N=240) n (%) Complete remission (CR) Partial remission (PR) Stable disease (SD) Progressive disease (PD)

12 Results - outcomes median follow-up of 5.7 y (range ) 5-year OS, 31% (95% CI, 25-37%) 5-year CSS, 42 % (95% CI, 35-49%) 5-year PFS was 26% (95% CI, 20-32%)

13 Results overall survival OS curves of pts receiving (red curve) or not anthracyclines in first line OS of pts receiving (red curve) or not rituximab in first line P= P<0.0001

14 Results cause specific survival CSS of pts receiving (red curve) or not a curative regimen containing both rituximab and anthracyclines in first line P<0.0001

15 Prognostic factors: Univariate analysis P-value for CSS P-value for OS Age NS.0116 ECOG Ps <.0001 <.0001 Stage < LDH <.0001 <.0001 No. of EN Sites Bulky Disease BM Involved.0450 NS Year Of Diagnosis Albumin <.0001 <.0001 Anemia Renal Failure.0001 <.0001 B-Symptoms NS.0143 Beta2-MG Rituximab+Doxorubicin <.0001 <.0001

16 Multivariate analysis of CSS

17 Multivariate analysis of OS

18 Conclusions One of the largest analysis of DLBCL >80 Age (80-85 vs > 85) was prognostic only for OS Charlson Comorbidity score did not appeared to be prognostic for either OS or CSS in this population Accurate selection of patients able to tolerate RCHOP/RCHOP-like regimens is crucial Selection should not only be based on age Fit patients should be treated with standard immuno-chemotherapy, which allows to achieve an excellent outcome