The Clinical Outcome of Newly Diagnosed Patients >60 Years of Age with Diffuse Large B-Cell Lymphoma (DLBCL) Treated with Standard or Liposomal Chemotherapies

Background:

Effective and safe treatment approaches are needed for diffuse large B-cell lymphoma (DLBCL) in the elderly. One approach is to substitute a chemotherapeutic agent with liposomal formulation, expecting greater anti-tumor activity and less toxicity . We have previously conducted two phase II studies using this approach: DRCOP (Clin Lymphoma Myeloma Leuk 2015), utilizing pegylated liposomal doxorubicin in place of conventional doxorubicin in RCHOP, and RCHMP (Brit J Haematol 2013), utilizing liposomal vincristine in place of conventional vincristine in RCHOP. We sought to compare the outcome of patients who are > 60 years of age with newly diagnosed DLBCL, and received DRCOP, RCHMP and RCHOP. This retrospective analysis was in part supported by Spectrum.

Methods:

The outcome of patients with DLBCL who were > 60 years old were analyzed from the study of DRCOP (DLBCL, n=79) and RCHMP (DLBCL elderly, n=32). In addition, we collected the outcome of patients > 60 years old who received standard RCHOP therapy in 2012 (n=39) from our Lymphoma Outcome Database. The baseline clinical characteristics including age adjusted IPI score (aaIPI), determined by stage, LDH and performance status were collected, along with progression free survival (PFS) and overall survival (OS). The retrospective study of patients with this population has been approved by the institutional review board.

Results:

The baseline characteristics were slightly different in all three groups, though statistically not significant; patients with aaIPI 2/3 were 40/79 (51%), 13/32 (40%) and 12/39 (31%) in DRCOP, RCHMP and RCHOP group, respectively (p=0.13). The 3-year PFS rates in aaIPI 0/1 group were 74%, 83% and 81%, respectively. The 3-year PFS rates in aaIPI 2/3 group were 52%, 67% and 48%, respectively. The 3-year OS rates in aaIPI 0/1 were 84%, 94% and 80%, respectively. The 3-year OS rates in aaIPI 2/3 were 63%, 77% and 65%, respectively. None of the survival differences were statistically significant. Kaplan-Meyer curves are shown in Figure.

Conclusion:

In summary, our data showed that liposomal formulation of chemotherapeutic agents produced similar survival outcome to standard therapy. The number of patients analyzed here is small, but these data support the idea of a randomized evaluation of RCHMP against standard RCHOP therapy in a prospective study in patients with DLBCL.