1 / 41

Journal reading

Journal reading. Diffuse large B cell lymphoma in elderly patients(>80 years old). British Journal of Haematology, 2012, 157, 159–170 Annals of Oncology 23: 1280–1286, 2012. R4 簡聖軒 指導老師 : 蕭樑材大夫. Outline. Characteristic in elderly patient Evaluation of elderly patient Prognostic factor

paki-irwin
Download Presentation

Journal reading

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Journal reading Diffuse large B cell lymphoma in elderly patients(>80 years old) British Journal of Haematology, 2012, 157, 159–170 Annals of Oncology 23: 1280–1286, 2012 R4 簡聖軒 指導老師: 蕭樑材大夫

  2. Outline • Characteristic in elderly patient • Evaluation of elderly patient • Prognostic factor • Treatment strategy

  3. 100年國人零歲平均餘命，男性為76.0歲，女性為82.7歲100年國人零歲平均餘命，男性為76.0歲，女性為82.7歲

  4. 100年65歲以上死亡數占全體死亡數之68.5%

  5. Difficult in treatment • Multiple co-morbid illness • Decreased portal/renal perfusion flow • Altered pharmacokinetics • Decreased bone marrow hematopioetic reserve • Poor compliance and tolerance • Exclude in clinical trial, no available guideline

  6. Evaluation-cumulative illness score

  7. Charlson score

  8. IPI/AA-IPI,/R-IPI,/E-IPI

  9. NHL 3 hematology centers Israel 1984-2004 age 80 years or older at diagnosis.

  10. Annals of Oncology 17: 928–934, 2006

  11. Annals of Oncology 17: 928–934, 2006

  12. Annals of Oncology 17: 928–934, 2006

  13. Discussion • Aggressive lymphoma increase with age, especially in patient age > 85 years • Complete response : 50 %, • In aggressive lymphoma, short survival median survival : 18 months 3 year survival rate: 35%

  14. Discussion • Prognostic parameter: IPI and PS • Aggressive chemotherapy had a significantly longer median survival than no or mild therapy • For with aggressive lymphoma, age alone should not be a contraindication for treatment

  15. Five regional Dutch cancer registries From 1997-2004 (N:419)

  16. After adjustment other variable, age and performance was independently associated with receiving CHOP like chemotherapy

  17. Toxicities and response • Grade 3-4 toxicity occurred in 67 % in CHOP like therapy , 40 % in milder regimen

  18. Survival

  19. Influence survival After correction aaIPI, The effect of therapy (in four subgroups) was independently associated with survival

  20. N Engl J Med 2002; 346:235-242

  21. R-CHOP VS CHOP in elderly • 60 - 80 years of age with diffise large B cell lymphoma , randomization mainly in France • stage II, III, or IV disease • ECOG of 0 to 2 (good to fair) • No history of indolent lymphoma central nervous system involvement, active cancer • Excluded if cardiac contraindication to doxorubicin therapy • Excluded neurologic contraindication to vincristine

  22. R-CHOP VS CHOP in elderly • G-CSF in grade 4 neutropenia • C+H decreased 50 % in > 2 x grade 4 neutropenia • C+H decreased 50 % Grade 3- 4 thrombocytopenia • If neutrophil < 1500 or platelet < 10000, hold Tx • If hold Tx > 2 wks, DC treatment plan • The doses of rituximab were not modified, but rituximab was discontinued when CHOP was stopped. • Treatment was stopped if lymphoma progressed

  23. Lancet Oncol 2011; 12: 460–68

  24. Procedure • Prospective, multicentre, single-arm, phase 2 study • GELA ran the study in 38 centers in France and Belgium • Age > 80 years with diffuse large B-cell lymphoma. ECOG< 2 • Rituximab + CHOP (R-miniCHOP) at 3-week intervals. • 375 mg/m2 rituximab, • 400 mg/m2 cyclophosphamide, • 25 mg/m2 doxorubicin, • 1 mg vincristine • 40 mg/m2 prednisone on days 1–5.

  25. G-CSF or erythropoietin support was left to the discretion of the treating physician. • Recommend G-CSF SC used on day 6-day13 if severe neutropenic fever until neutrophil >1000 • Hold theray if neutrophil < 1000, if neutophil still < 1000 for more than 28 days, treatment DC

  26. Association of deaths with treatment during treatment phase

  27. Response 108/149 complete 6 X R-miniCHOP Median survival was 21 months 2 year prgoression free survival 47% 58 death report: 33 lymphoma progression 12 toxicities of treatment Most frequently side effeict : hematological toxicity >3 grade neutropenia : 59 Febrile neutropenia : 11

  28. Median overall survival was 29 months

  29. Conclusion • 29 months median survival • 62% complete response rate (CR+uCR) • The only parameter associated with poor outcome is low serum albumin • Death from toxicity in previous study: 9%-23%, but 5 death in first cycle in this study • Despite absence of a control arm. This study suggest selected patient older than 80 years with DLBCL in good performance, R-miniCHOP is considered

  30. Take home message • Treatment in very elderly patient is no more rare pratice • As age increased, aggressive lymphoma is more popular • Adequate evaluation is essential for treatment decision, suitable for elderly tool • Performance, LDH, albumin are most import prognostic factor

  31. Take home message • Age would not be contraindication for therapy • Median survival: 18-20 months and complete response: 50 % in treatment population • Treatment with Rituximab and reduced dose of chemotherapy would be acceptable strategy

More Related