Korean J Intern Med.  2015 Sep;30(5):684-693. 10.3904/kjim.2015.30.5.684.

Clinical characteristics and outcomes in diffuse large B cell lymphoma patients aged 70 years and older: a single-center experience with a literature review

• Jung YH
• Woo IS
• Han CW

• KMID: 2381567
• DOI: http://doi.org/10.3904/kjim.2015.30.5.684

Abstract

BACKGROUND/AIMS
Among diffuse large B cell lymphoma (DLBCL) patients, determining the appropriate dose and chemotherapy schedule to balance toxicity and efficacy is harder in elderly than in younger patients. Moreover, there are no currently available clinical factors that consistently identify patients who are unfit to receive chemotherapy. Therefore, the clinical characteristics and outcomes of elderly patients with DLBCL and the causes of treatment-related death were investigated in this study.
METHODS
The clinical characteristics and outcomes of 44 elderly (> or = 70 years of age) patients diagnosed with DLBCL between January 2005 and June 2013 were evaluated. Variable clinical data along with the response rate, overall survival (OS), and causes of treatment-related death or treatment interruption were investigated.
RESULTS
The median OS was 18.6 months, and 19 patients completed curative treatment. The mean average relative dose intensity of adriamycin in patients who completed chemotherapy was 0.617, and of these patients, 16 achieved complete remission. Chemotherapy incompletion, infectious complications, ex tranoda l involvement, high lactate dehydrogenase, poor performance status, and low albumin level at diagnosis were related to a shorter OS. However, multivariate analysis revealed that only infections and chemotherapy incompletion were significantly related to poor prognosis. The most common cause of treatment-related death was infection, and patients who had experienced infectious complications tended to have lower albumin levels than those of patients without such complications.
CONCLUSIONS
In the treatment of elderly lymphoma patients, the dose intensity of adriamycin is not as important as it is in young patients. However, in elderly patients, infections are particularly dangerous, especially in patients with low albumin levels.

Keyword

Lymphoma, large B-cell, diffuse; Aged; Infection; Albumins

MeSH Terms

Age Factors
Aged
Aged, 80 and over
Antibiotics, Antineoplastic/*administration & dosage/adverse effects
Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use
Chi-Square Distribution
Communicable Diseases/blood/diagnosis/mortality
Disease Progression
Doxorubicin/*administration & dosage/adverse effects
Female
Geriatric Assessment
Humans
Kaplan-Meier Estimate
Lymphoma, Large B-Cell, Diffuse/blood/diagnosis/*drug therapy/mortality
Male
Multivariate Analysis
Proportional Hazards Models
Remission Induction
Republic of Korea
Retrospective Studies
Risk Factors
Serum Albumin/analysis
Time Factors
Treatment Outcome
Antibiotics, Antineoplastic
Doxorubicin
Serum Albumin