Elderly patients with DLBCL see improved survival with at least six treatments
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NEW ORLEANS — Patients older than 80 years of age with diffuse large B-cell lymphoma more than tripled their overall survival when receiving at least six cycles of chemotherapy.
“Given that the incidence of diffuse large B-cell lymphoma has been increasing over the age of 65 years, therapeutic approaches that optimize treatment efficacy while minimizing toxicity is needed,” Snegha Ananth, MD, of South Texas Veterans Health Care System, San Antonio, Texas, said during her poster presentation. “With the advent of genomic profiling and identification of molecular abnormalities in diffuse large B-cell lymphoma, novel antibodies and small molecules with low toxicity can increase tolerance in the upfront settings leading more elderly patients toward completion of necessary lines of treatment, thereby improving their overall survival.”
Ananth and colleagues identified 2,697 patients who met inclusion criteria of being treated for DLBCL between 2011 and 2019 at the VA without other diagnoses, outside treatment or incomplete records. Of these, 916 were younger than 65 years of age; 1,390 were between 65 and 79 years of age; and 391 were older than 80 years of age.
ECOG status remained between zero and two for more than two-thirds of patients in each of the age stratifications. Hit status, stage at diagnosis and cell of origin were all similar between groups.
Treatments given did differ in that the percentage of patients who received no treatment increased with the age groups (3.2% vs. 6% vs. 20.7% in < 65, 65-79 and > 80-year groups, respectively; P < .001) while the percentage of those receiving two or more lines of treatment decreased with age (10.2% vs. 7.5% vs. 2.3%, P < .001).
In line with that finding, Ananth reported that patients younger than 65 years of age were more likely to complete six cycles when compared with the older age groups (73.9% vs. 67.8% vs. 59.8%; P < .001). Patients in the oldest age group were more likely to receive R-mini-CHOP than their younger counterparts (0.3% vs. 2.1% vs. 15.1%).
Median OS decreased as age increased, but receiving more than six cycles of anthracycline-based chemotherapy showed a jump in survival in each age group, with the biggest difference seen in the oldest age group.
Those younger than 65 years of age had median OS of 46.3 months with one to five cycles vs. 75.5 months with six or more. Those older than 65 years of age had a median OS of 29.1 months with one to five cycles and 62.5 months with six or more.
Broken down, those aged 65 to 79 years of age saw 35 months median OS with one to five cycles of treatment vs. 64.7 months with six or more cycles. Those 80 years of age or older achieved 13.8 months median OS with one to five treatment cycles, but when receiving six or more, their median OS jumped to 46.5 months.
“People who receive more than six cycles across every age group had longer median overall survival when compared [with] people who got less than six cycles,” Ananth said. “What’s interesting to note is that this difference is most starkly seen in the more than 80 years old group as we can see there’s almost a three-fold increase in the median overall survival among patients who receive six or more cycles of anthracycline-based chemotherapy.”
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Ananth S, et al. Poster 2276. Presented at: ASH Annual Meeting and Exposition; Dec. 10-13, 2022; New Orleans.
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