Octogenarian patients with diffuse large B-cell lymphoma are managed mainly with palliation, but recent improvement in their overall condition makes potentially curative treatment a possibility. Studies have shown that half of selected octogenarians may be cured using reduced-dose anthracycline chemoimmunotherapy. However, patients aged >85 (late octogenarians [LO]) were underrepresented, and selection criteria were poorly defined. We analyzed the clinical characteristics and outcomes of LO enrolled in the FIL Elderly Project in terms of the treatment received (palliative vs. curative) and of their simplified geriatric assessment (sGA), then compared them with early octogenarians (EO) aged 80-84 and with those aged 65-79 classified as UNFIT or FRAIL according to sGA enrolled in the same study. Of the 1,163 patients, 370 were >80 and 129 LO. Clinical characteristics were similar between LO and EO, but LO more frequently received palliation (50% vs. 23%; P=0.001) and had worse 2-year overall survival (OS) (48% vs. 63%; P=0.001) and 2-year progression-free survival (PFS) (43% vs. 56%; P=0.01). Patients receiving anthracycline did better than patients receiving palliation (P<0.001), without any difference between full or reduced doses. Rituximab within palliation improved outcome (2-yr OS with or without rituximab 42% vs. 22%; P=0.008). Elderly Prognostic Index (EPI) performed better than sGA in identifying different risk categories, and high-risk EPI retained an independent unfavorable effect on OS and PFS, together with treatment without anthracycline. In conclusion, late octogenarians can benefit from a curative approach with reduced-dose anthracycline and from rituximab within palliation. EPI may help in patient selection more than sGA can.

Diffuse large B-cell lymphoma in octogenarians aged 85 and older can benefit from treatment with curative intent: a report on 129 patients prospectively registered in the Elderly Project of the Fondazione Italiana Linfomi (FIL) / Tucci, A.; Merli, F.; Fabbri, A.; Marcheselli, L.; Pagani, C.; Puccini, B.; Marino, D.; Zanni, M.; Pennese, E.; Flenghi, L.; Arcari, A.; Botto, B.; Celli, M.; Mammi, C.; Re, A.; Campostrini, G.; Tafuri, A.; Zilioli, V. R.; Cencini, E.; Sartori, R.; Bottelli, C.; Merli, M.; Petrucci, L.; Gini, G.; Balzarotti, M.; Cavallo, F.; Musuraca, G.; Luminari, S.; Rossi, G.; Spina, M.. - In: HAEMATOLOGICA. - ISSN 0390-6078. - 108:4(2023), pp. 1083-1091. [10.3324/haematol.2022.281407]

Diffuse large B-cell lymphoma in octogenarians aged 85 and older can benefit from treatment with curative intent: a report on 129 patients prospectively registered in the Elderly Project of the Fondazione Italiana Linfomi (FIL)

Luminari S.;
2023

Abstract

Octogenarian patients with diffuse large B-cell lymphoma are managed mainly with palliation, but recent improvement in their overall condition makes potentially curative treatment a possibility. Studies have shown that half of selected octogenarians may be cured using reduced-dose anthracycline chemoimmunotherapy. However, patients aged >85 (late octogenarians [LO]) were underrepresented, and selection criteria were poorly defined. We analyzed the clinical characteristics and outcomes of LO enrolled in the FIL Elderly Project in terms of the treatment received (palliative vs. curative) and of their simplified geriatric assessment (sGA), then compared them with early octogenarians (EO) aged 80-84 and with those aged 65-79 classified as UNFIT or FRAIL according to sGA enrolled in the same study. Of the 1,163 patients, 370 were >80 and 129 LO. Clinical characteristics were similar between LO and EO, but LO more frequently received palliation (50% vs. 23%; P=0.001) and had worse 2-year overall survival (OS) (48% vs. 63%; P=0.001) and 2-year progression-free survival (PFS) (43% vs. 56%; P=0.01). Patients receiving anthracycline did better than patients receiving palliation (P<0.001), without any difference between full or reduced doses. Rituximab within palliation improved outcome (2-yr OS with or without rituximab 42% vs. 22%; P=0.008). Elderly Prognostic Index (EPI) performed better than sGA in identifying different risk categories, and high-risk EPI retained an independent unfavorable effect on OS and PFS, together with treatment without anthracycline. In conclusion, late octogenarians can benefit from a curative approach with reduced-dose anthracycline and from rituximab within palliation. EPI may help in patient selection more than sGA can.
2023
108
4
1083
1091
Diffuse large B-cell lymphoma in octogenarians aged 85 and older can benefit from treatment with curative intent: a report on 129 patients prospectively registered in the Elderly Project of the Fondazione Italiana Linfomi (FIL) / Tucci, A.; Merli, F.; Fabbri, A.; Marcheselli, L.; Pagani, C.; Puccini, B.; Marino, D.; Zanni, M.; Pennese, E.; Flenghi, L.; Arcari, A.; Botto, B.; Celli, M.; Mammi, C.; Re, A.; Campostrini, G.; Tafuri, A.; Zilioli, V. R.; Cencini, E.; Sartori, R.; Bottelli, C.; Merli, M.; Petrucci, L.; Gini, G.; Balzarotti, M.; Cavallo, F.; Musuraca, G.; Luminari, S.; Rossi, G.; Spina, M.. - In: HAEMATOLOGICA. - ISSN 0390-6078. - 108:4(2023), pp. 1083-1091. [10.3324/haematol.2022.281407]
Tucci, A.; Merli, F.; Fabbri, A.; Marcheselli, L.; Pagani, C.; Puccini, B.; Marino, D.; Zanni, M.; Pennese, E.; Flenghi, L.; Arcari, A.; Botto, B.; Celli, M.; Mammi, C.; Re, A.; Campostrini, G.; Tafuri, A.; Zilioli, V. R.; Cencini, E.; Sartori, R.; Bottelli, C.; Merli, M.; Petrucci, L.; Gini, G.; Balzarotti, M.; Cavallo, F.; Musuraca, G.; Luminari, S.; Rossi, G.; Spina, M.
File in questo prodotto:
File Dimensione Formato  
1081083.pdf

Open access

Tipologia: Versione pubblicata dall'editore
Dimensione 661.12 kB
Formato Adobe PDF
661.12 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1314060
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 9
  • ???jsp.display-item.citation.isi??? 9
social impact