Cancer Res Treat.  2016 Jan;48(1):304-311. 10.4143/crt.2014.339.

Reduced Dose Intensities of Doxorubicin in Elderly Patients with DLBCL in Rituximab Era

• Ha H
• Keam B
• Kim TM
• Jeon YK
• Lee SH
• Kim DW
• Kim CW
• Heo DS

• KMID: 2152289
• DOI: http://doi.org/10.4143/crt.2014.339

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 cannot 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 > or = 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 > or = 70 years. We analyzed the survival outcomes according to DID.
RESULTS
Significantly poorer overall survival (OS) was observed for patients aged > or = 70 years (2-year OS rate: 59.9% vs. 84.2%; p < 0.001). DID < or = 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 < or = 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 mortality 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.

Keyword

Diffuse large B-cell lymphoma; Age groups; Doxorubicin

MeSH Terms

Aged*
Anthracyclines
Disease-Free Survival
Doxorubicin*
Humans
Lymphoma, B-Cell
Mortality
Seoul
Anthracyclines
Doxorubicin