Reduced Dose Intensities of Doxorubicin in Elderly Patients with DLBCL in Rituximab Era
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose The dose intensity of doxorubicin (DID) is important to the survival of diffuse large B cell lymphoma (DLBCL) patients. However, due to expected toxicities, most elderly patients can- not receive full doses of anthracyclines. The purpose of this study was to evaluate the effect of DID on the survival of elderly DLBCL patients (age ! 70 years) in the rituximab era. Materials and Methods We analyzed 433 DLBCL patients who were treated with R-CHOP between December 2003 and October 2011 at the Seoul National University Hospital. Of these patients, 19.2% were aged ! 70 years. We analyzed the survival outcomes according to DID. Results Significantly poorer overall survival (OS) was observed for patients aged ! 70 years (2-year OS rate: 59.9% vs. 84.2%; p < 0.001). DID " 10 mg/m2/wk had a significant effect on the OS and progression-free survival (PFS) in elderly patients (2-year OS rate: 40.0% in DID " 10 mg/m2/wk vs. 62.6% in DID > 10 mg/m2/wk; p=0.031; 2-year PFS: 35.0% vs. 65.7%; p=0.036). The OS on each 1.7 mg/m2/wk doxorubicin increment above 10 mg/m2/wk in elderly patients was not significant among the groups (2-year OS rate: 75.0% in DID 10.0- 11.7 mg/m2/wk vs. 66.7% in DID 15.0-16.7 mg/m2/wk; p=0.859). Treatment related mor- tality was not related to DID. Conclusion DID can be reduced up to 10 mg/m2/wk in elderly DLBCL patients in the rituximab era. Maintenance of DID > 10 mg/m2/wk and judicious selection of elderly patients who are tolerant to DID is necessary.
Abstract
Purpose The dose intensity of doxorubicin (DID) is important to the survival of diffuse large B cell lymphoma (DLBCL) patients. However, due to expected toxicities, most elderly patients can- not receive full doses of anthracyclines. The purpose of this study was to evaluate the effect of DID on the survival of elderly DLBCL patients (age ! 70 years) in the rituximab era. Materials and Methods We analyzed 433 DLBCL patients who were treated with R-CHOP between December 2003 and October 2011 at the Seoul National University Hospital. Of these patients, 19.2% were aged ! 70 years. We analyzed the survival outcomes according to DID. Results Significantly poorer overall survival (OS) was observed for patients aged ! 70 years (2-year OS rate: 59.9% vs. 84.2%; p < 0.001). DID " 10 mg/m2/wk had a significant effect on the OS and progression-free survival (PFS) in elderly patients (2-year OS rate: 40.0% in DID " 10 mg/m2/wk vs. 62.6% in DID > 10 mg/m2/wk; p=0.031; 2-year PFS: 35.0% vs. 65.7%; p=0.036). The OS on each 1.7 mg/m2/wk doxorubicin increment above 10 mg/m2/wk in elderly patients was not significant among the groups (2-year OS rate: 75.0% in DID 10.0- 11.7 mg/m2/wk vs. 66.7% in DID 15.0-16.7 mg/m2/wk; p=0.859). Treatment related mor- tality was not related to DID. Conclusion DID can be reduced up to 10 mg/m2/wk in elderly DLBCL patients in the rituximab era. Maintenance of DID > 10 mg/m2/wk and judicious selection of elderly patients who are tolerant to DID is necessary.
참고문헌 (24)
- Morton LM, "Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001", Blood, 107, pp.265~276 (2006)
- Armitage JO, "Treatment of non-Hodgkin's lymphoma", N Engl J Med, 328, pp.1023~1030 (1993)
- Coiffier B, "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", Blood, 116, pp.2040~2045 (2010)
- Tirelli U, "CHOP is the standard regimen in patients > or = 70 years of age with intermediate-grade and high-grade non-Hodgkin's lymphoma : results of a randomized study of the European Organization for Research and Treatment of Cancer Lymphoma Cooperative Study Group", J Clin Oncol, 16, pp.27~34 (1998)
- Armitage JO, "Is lymphoma occurring in the elderly the same disease?", Leuk Lymphoma, 49, pp.14~16 (2008)
- Huntington SF, "Toxicities and outcomes among septuagenarians and octogenarians with diffuse large B-cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone therapy", Leuk Lymphoma, 53, pp.1461~1468 (2012)
- Lee KW, "Doxorubicin-based chemotherapy for diffuse large B-cell lymphoma in elderly patients : comparison of treatment outcomes between young and elderly patients and the significance of doxorubicin dosage", Cancer, 98, pp.2651~2656 (2003)
- Coiffier B, "CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma", N Engl J Med, 346, pp.235~242 (2002)
- Shin HJ, "Addition of rituximab to reduced-dose CHOP chemotherapy is fea-sible for elderly patients with diffuse large B-cell lymphoma", Cancer Chemother Pharmacol, 69, pp.1165~1172 (2012)
- Feugier P, "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 Clin Oncol, 23, pp.4117~4126 (2005)
- Bastion Y, "Elderly patients with aggressive non-Hodgkin's lymphoma : disease presentation, response to treatment, and survival : a Groupe d'Etude des Lymphomes de l'Adulte study on 453 patients older than 69 years", J Clin Oncol, 15, pp.2945~2953 (1997)
- Campo E, "The 2008 WHO classification of lymphoid neoplasms and beyond : evolving concepts and practical applications", Blood, 117, pp.5019~5032 (2011)
- Cheson BD, "Revised response criteria for malignant lymphoma", J Clin Oncol, 25, pp.579~586 (2007)
- Hryniuk WM, "The calculation of received dose intensity", J Clin Oncol, 8, pp.1935~1937 (1990)
- Arcaini L, "Prognostic assessment in patients with indolent B-cell lymphomas", Scientific-WorldJournal, 2012, pp.107892~ (2012)
- Sehn LH, "The revised International Prognostic Index(R-IPI)is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP", Blood, 109, pp.1857~1861 (2007)
- Peyrade F, "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", Lancet Oncol, 12, pp.460~468 (2011)
- Tsai HT, "The effects of cardiovascular disease on the clinical outcome of elderly patients with diffuse large B-cell lymphoma", Leuk Lymphoma, 56, pp.682~687 (2015)
- Sonneveld P, "Comparison of doxorubicin and mitoxantrone in the treatment of elderly patients with advanced diffuse non-Hodgkin's lymphoma using CHOP versus CNOP chemotherapy", J Clin Oncol, 13, pp.2530~2539 (1995)
- Tilly H, "A randomized comparison of ACVBP and CHOP in the treatment of advanced aggressive non-Hodgkin's lymphoma : the LNH93-5 study", Blood, 96, pp.832~ (2000)
- Herbrecht R, "Comparison of pixantrone-based regimen(CPOP-R)with doxorubicin-based therapy(CHOP-R)for treatment of diffuse large B-cell lymphoma", Ann Oncol, 24, pp.2618~2623 (2013)
- Kreher S, "R-split-CHOP chemotherapy for elderly patients with diffuse large B-cell lymphoma", Eur J Haematol, 93, pp.70~76 (2014)
- A predictive model for aggressive non-Hodgkin's lymphoma, "The International Non-Hodgkin's Lymphoma Prognostic Factors Project", N Engl J Med, 329, pp.987~994 (1993)
- Advani RH, "Comparison of conventional prognostic indices in patients older than 60 years with diffuse large B-cell lymphoma treated with R-CHOP in the US Intergroup Study(ECOG 4494, CALGB 9793) : consideration of age greater than 70 years in an elderly prognostic index(E-IPI)", Br J Haematol, 151, pp.143~151 (2010)