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Erschienen in: memo - Magazine of European Medical Oncology 1/2016

01.02.2016 | short review

Treatment of elderly patients with diffuse large B-cell lymphoma

verfasst von: Thomas Nösslinger, MD

Erschienen in: memo - Magazine of European Medical Oncology | Ausgabe 1/2016

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Abstract

With the implementation of rituximab, tremendous progress has been achieved in the treatment of diffuse large B-cell lymphoma (DLBCL). Nevertheless, the majority of patients with DLBCL are over the age of 65 years and the management of these patients is often suboptimal. Standard chemo-immunotherapy with curative approach should be appropriate for all elderly patients who can tolerate it. Therefore, a careful evaluation of each patient is mandatory prior to treatment allocation. R- CHOP regimen (rituximab, cyclophosphamide doxorubicin, vincristine, prednisolone) remains the standard of care, but special attention has to be paid to rigorous supportive care. Patients not fit enough for R-CHOP are candidates for dose-reduced therapy or other palliative strategies.
Literatur
1.
Zurück zum Zitat Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31:128–36.CrossRefPubMed Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31:128–36.CrossRefPubMed
3.
Zurück zum Zitat Ott G, Ziepert M, Klapper W, et al. Immunoblastic morphology, but not the immune-histochemical GCB/non-GCB classfier, predicts outcome in diffuse large B-cell lymphoma in the RICOVER-60 trial. Blood. 2010;116(23):4916–25.CrossRefPubMed Ott G, Ziepert M, Klapper W, et al. Immunoblastic morphology, but not the immune-histochemical GCB/non-GCB classfier, predicts outcome in diffuse large B-cell lymphoma in the RICOVER-60 trial. Blood. 2010;116(23):4916–25.CrossRefPubMed
4.
Zurück zum Zitat Thunberg U, Enblad G, Berglund M. Classification of diffuse large B-cell lymphoma by immunohistochemistry demonstrates that elderly patients are more common in the non-GC subgroup and younger patients in the GC subgroup. Haematologica. 2012;97(2):e3; author reply e4.CrossRefPubMedPubMedCentral Thunberg U, Enblad G, Berglund M. Classification of diffuse large B-cell lymphoma by immunohistochemistry demonstrates that elderly patients are more common in the non-GC subgroup and younger patients in the GC subgroup. Haematologica. 2012;97(2):e3; author reply e4.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive Non-Hodgkin’s Lymphoma. N Engl J Med. 1993;329:987–94.CrossRef The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive Non-Hodgkin’s Lymphoma. N Engl J Med. 1993;329:987–94.CrossRef
6.
Zurück zum Zitat Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood. 2014;123(6):837–42.CrossRefPubMed Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood. 2014;123(6):837–42.CrossRefPubMed
7.
Zurück zum Zitat Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059–68.CrossRefPubMed Cheson BD, Fisher RI, Barrington SF, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059–68.CrossRefPubMed
8.
Zurück zum Zitat Savage K, Zeynalova S, Kansara R, et al. Validation of a prognostic model to assess the risk of CNS disease in patients with aggressive B-cell lymphoma. Blood (ASH Annual Meeting Abstracts), 124: 2014, (abstr 394). Savage K, Zeynalova S, Kansara R, et al. Validation of a prognostic model to assess the risk of CNS disease in patients with aggressive B-cell lymphoma. Blood (ASH Annual Meeting Abstracts), 124: 2014, (abstr 394).
9.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed
10.
Zurück zum Zitat Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16(5):622–6.CrossRefPubMed Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16(5):622–6.CrossRefPubMed
11.
Zurück zum Zitat Sorror ML, Sandmaier BM, Storer BE, et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. 2007;25(27):4246–54.CrossRefPubMed Sorror ML, Sandmaier BM, Storer BE, et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. 2007;25(27):4246–54.CrossRefPubMed
12.
Zurück zum Zitat Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25(14):1824–31.CrossRefPubMed Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25(14):1824–31.CrossRefPubMed
13.
Zurück zum Zitat Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale. Psychiatry Res. 1992;41(3):237–48.CrossRefPubMed Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale. Psychiatry Res. 1992;41(3):237–48.CrossRefPubMed
14.
Zurück zum Zitat Wilson WH, Jung SH, Porcu P, et al. A cancer and leukemia group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype. Haematologica. 2012;97(5):758–65.CrossRefPubMedPubMedCentral Wilson WH, Jung SH, Porcu P, et al. A cancer and leukemia group B multi-center study of DA-EPOCH-rituximab in untreated diffuse large B-cell lymphoma with analysis of outcome by molecular subtype. Haematologica. 2012;97(5):758–65.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Stiff PJ, Unger JM, Cook JR, et al. Autologous transplantation as consolidation for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 2013;369(18):1681–90.CrossRefPubMedPubMedCentral Stiff PJ, Unger JM, Cook JR, et al. Autologous transplantation as consolidation for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 2013;369(18):1681–90.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Fields A, Linch D. Treatment of the elderly patient with diffuse large B cell lymphoma. Br J Haematol. 2012;157:159–70.CrossRefPubMed Fields A, Linch D. Treatment of the elderly patient with diffuse large B cell lymphoma. Br J Haematol. 2012;157:159–70.CrossRefPubMed
17.
Zurück zum Zitat Pfreundschuh M, Trumper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104(3):634–41.CrossRefPubMed Pfreundschuh M, Trumper L, Kloess M, et al. Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood. 2004;104(3):634–41.CrossRefPubMed
18.
Zurück zum Zitat Pfreundschuh M. How I treat elderly patients with diffuse large B-cell lymphoma. Blood. 2010;116(24):5103–10.CrossRefPubMed Pfreundschuh M. How I treat elderly patients with diffuse large B-cell lymphoma. Blood. 2010;116(24):5103–10.CrossRefPubMed
19.
Zurück zum Zitat Persky DO, Unger JM, Spier CM, et al. Phase II study of rituximab plus three cycles of CHOP and involved-field radiotherapy for patients with limited-stage aggressive B-cell lymphoma: southwest Oncology Group study 0014. J Clin Oncol. 2008;26(14):2258–63.CrossRefPubMed Persky DO, Unger JM, Spier CM, et al. Phase II study of rituximab plus three cycles of CHOP and involved-field radiotherapy for patients with limited-stage aggressive B-cell lymphoma: southwest Oncology Group study 0014. J Clin Oncol. 2008;26(14):2258–63.CrossRefPubMed
20.
Zurück zum Zitat Lamy T, Damaj G, Gyan E, et al. R-CHOP with or without radiotherapy in non-bulky limited-stage diffuse large B-cell lymphoma (DLBCL): preliminary results of the prospective randomized phase III 02–03 trial from the Lysa/Goelams group. Blood (ASH Annual Meeting Abstracts), 124: 2014, (abstr 393). Lamy T, Damaj G, Gyan E, et al. R-CHOP with or without radiotherapy in non-bulky limited-stage diffuse large B-cell lymphoma (DLBCL): preliminary results of the prospective randomized phase III 02–03 trial from the Lysa/Goelams group. Blood (ASH Annual Meeting Abstracts), 124: 2014, (abstr 393).
21.
Zurück zum Zitat Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(4):235–42.CrossRefPubMed Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346(4):235–42.CrossRefPubMed
22.
Zurück zum Zitat Pfreundschuh M, Schubert J, Ziepert M, et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20 + B-cell lymphomas: a randomized controlled trial (RICOVER-60). Lancet Oncol. 2008;9(2):105–16.CrossRefPubMed Pfreundschuh M, Schubert J, Ziepert M, et al. Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20 + B-cell lymphomas: a randomized controlled trial (RICOVER-60). Lancet Oncol. 2008;9(2):105–16.CrossRefPubMed
23.
Zurück zum Zitat Cunningham D, Hawkes EA, Jack A, et al. Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone in patients with newly diagnosed diffuse large B-cell non-Hodgkin lymphoma: a phase 3 comparison of dose intensification with 14-day versus 21-day cycles. Lancet. 2013;381(9880):1817–26.CrossRefPubMed Cunningham D, Hawkes EA, Jack A, et al. Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone in patients with newly diagnosed diffuse large B-cell non-Hodgkin lymphoma: a phase 3 comparison of dose intensification with 14-day versus 21-day cycles. Lancet. 2013;381(9880):1817–26.CrossRefPubMed
24.
Zurück zum Zitat Delarue R, Tilly H, Mounier N, et al. Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. Lancet Oncol. 2013;14(6):525–33.CrossRefPubMed Delarue R, Tilly H, Mounier N, et al. Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. Lancet Oncol. 2013;14(6):525–33.CrossRefPubMed
25.
Zurück zum Zitat Held G, Murawski N, Ziepert M, et al. Role of radiotherapy to bulky disease in elderly patients with aggressive B-cell lymphoma. J Clin Oncol. 2014;32(11):1112–8.CrossRefPubMed Held G, Murawski N, Ziepert M, et al. Role of radiotherapy to bulky disease in elderly patients with aggressive B-cell lymphoma. J Clin Oncol. 2014;32(11):1112–8.CrossRefPubMed
26.
Zurück zum Zitat Peyrade F, Jardin F, Thieblemont C, et al. 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. 2011;12(5):460–8.CrossRefPubMed Peyrade F, Jardin F, Thieblemont C, et al. 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. 2011;12(5):460–8.CrossRefPubMed
27.
Zurück zum Zitat Fridrik M, Petzer A, Keil F, et al. Non-pegylated liposomal encapsulated doxorubicin reduces cardiotoxicity in 1st line treatment of diffuse large B-cell lymphoma (DLBCL). Final Results of a Randomized Trial Blood (ASH Annual Meeting Abstracts), 118: 2011, (abstr 2676). Fridrik M, Petzer A, Keil F, et al. Non-pegylated liposomal encapsulated doxorubicin reduces cardiotoxicity in 1st line treatment of diffuse large B-cell lymphoma (DLBCL). Final Results of a Randomized Trial Blood (ASH Annual Meeting Abstracts), 118: 2011, (abstr 2676).
28.
Zurück zum Zitat Weidmann E, Neumann A, Fauth F, et al. Phase II study of bendamustine in combination with rituximab as first-line treatment in patients 80 years or older with aggressive B-cell lymphomas. Ann Oncol. 2011;22(8):1839–44.CrossRefPubMed Weidmann E, Neumann A, Fauth F, et al. Phase II study of bendamustine in combination with rituximab as first-line treatment in patients 80 years or older with aggressive B-cell lymphomas. Ann Oncol. 2011;22(8):1839–44.CrossRefPubMed
29.
Zurück zum Zitat Ferreri AJ, Reni M, Foppoli M, et al. High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet. 2009;374(9700):1512–20.CrossRefPubMed Ferreri AJ, Reni M, Foppoli M, et al. High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet. 2009;374(9700):1512–20.CrossRefPubMed
30.
Zurück zum Zitat El Gnaoui T, Dupuis J, Belhadj K, et al. Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy. Ann Oncol. 2007;18(8):1363–8.CrossRefPubMed El Gnaoui T, Dupuis J, Belhadj K, et al. Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy. Ann Oncol. 2007;18(8):1363–8.CrossRefPubMed
31.
Zurück zum Zitat Pettengell R, Coiffier B, Narayanan G, et al. Pixantrone dimaleate versus other chemotherapeutic agents as a single-agent salvage treatment in patients with relapsed or refractory aggressive non-Hodgkin lymphoma: a phase 3, multicentre, open-label, randomised trial. Lancet Oncol. 2012;13(7):696–706. (Erratum in: Lancet Oncol. 2012 Jul;13(7):e285).CrossRefPubMed Pettengell R, Coiffier B, Narayanan G, et al. Pixantrone dimaleate versus other chemotherapeutic agents as a single-agent salvage treatment in patients with relapsed or refractory aggressive non-Hodgkin lymphoma: a phase 3, multicentre, open-label, randomised trial. Lancet Oncol. 2012;13(7):696–706. (Erratum in: Lancet Oncol. 2012 Jul;13(7):e285).CrossRefPubMed
Metadaten
Titel
Treatment of elderly patients with diffuse large B-cell lymphoma
verfasst von
Thomas Nösslinger, MD
Publikationsdatum
01.02.2016
Verlag
Springer Vienna
Erschienen in
memo - Magazine of European Medical Oncology / Ausgabe 1/2016
Print ISSN: 1865-5041
Elektronische ISSN: 1865-5076
DOI
https://doi.org/10.1007/s12254-016-0248-6

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