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Rituximab, Anthracycline Have Benefits in Oldest Patients With Diffuse Large B-Cell Lymphoma

Jared Kaltwasser
Most studies of patients with diffuse large B-cell lymphoma do not include those over the age of 80. However, a new study says those patients, like younger patients, benefit from receiving rituximab and anthracycline in their chemotherapy regimens when possible.
 
The clinical benefits of including rituximab and anthracycline in the treatment of diffuse large B-cell lymphoma (DLBCL) extend even to very elderly patients, according to new research. The results are important because they provide real-world evidence supporting the drugs’ use in patients that have previously been excluded from clinical trials due to advanced age.

Writing in the journal Immunity & Ageing, corresponding author Fei-Yuan Hsaio, PhD, of the School of Pharmacy at National Taiwan University, in Taipei, noted that the standard frontline therapy for patients with DLBCL is the R-CHOP regimen. However, both of the key trials used to validate the rituximab-inclusive therapy included patients ranging in age from 60 to 80, leaving uncertain whether or not the approach is appropriate for patients over the age of 80. The matter is particularly important, the authors note, given the potential of rituximab to increase the risk of opportunistic infections.

Meanwhile, another open question is the use of anthracycline in these patients. That drug has noted cardiac toxicity, and just like rituximab, most studies have thus far focused on patients between 60 and 80 years old.

Hoping to achieve more conclusive answers, Hsiao and colleagues pulled data from the Taiwan Cancer Registry Database, which includes more than 90% of Taiwan’s cancer cases. Those data were cross-referenced with the country’s National Health Insurance Research Database and its National Death Registry to identify patients with DLBCL over the age of 60 who received either the R-CHOP regimen, R-CVP, CHOP, or CVP. The authors then compared outcomes in patients between 60 and 79 years to those of patients 80 years of age and older.

A total of 3228 patients were eligible for the study following the search. Of those, the majority (2559) were in the younger cohort, due largely to the fact that the median age at diagnosis was in the early 60s. The team reported that patients in each age group had similar Ann Arbor stages at diagnosis, though the older cohort had higher rates of comorbidities such as congestive heart failure and dementia, among others.

The authors found that patients in the younger group received R-CHOP therapy more often than those in the 80+ cohort. Also, within the younger cohort, patients who were prescribed the R-CVP and CVP regimens tended to be older.

The authors assessed overall survival (OS) and time to treatment failure (TTF) in both cohorts. They found R-CHOP, younger age, and lower Ann Arbor score were associated with better overall survival (OS) and time to treatment failure (TTF) in both age groups.

“We showed that adding rituximab or anthracycline not only improved the prognosis in the majority of DLBCL patients aged between 60 and 79 years but also in the extremely elderly patients,” Hsiao and colleagues wrote. “These findings provide real-world evidence supporting the benefits of rituximab and anthracycline.”

The authors noted some limitations. Among them, the database did not allow them to know whether patients received R-CHOP or R-miniCHOP. The data also did not include side effects of chemotherapy. Data limitations also made it impossible to calculate international prognostic index scores, the authors said, though some of the factors included in those scores, such as Ann Arbor score, were included.

Reference

Huang HH, Ko BS, Chen HM, Chen LJ, Wang CY, Hsiao FY. Frontline treatments in extremely elderly patients with diffuse large B-cell lymphoma: a population-based study in Taiwan, 2010-2015. Immun Ageing. Published online June 10, 2020. doi:10.1186/s12979-020-00188-8

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