Non-anthracycline chemotherapy associated with a poor outcome in elderly Egyptian patients with diffuse large B-cell non-Hodgkin lymphoma

Zeeneldin AA, Sallam YA, Gaber AA, Shaheen AA. Non-anthracycline chemotherapy as

Ahmed A Zeeneldin, Yasser A Sallam, Ayman A Gaber,

Department of Medical Oncology, National Cancer In

2015

76-83

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Aim: Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) is the standard treatment for patients with diffuse large B-cell non-Hodgkin lymphoma (DLBCNHL). Nevertheless, anthracyclines are contraindicated for some patients, e.g. cardiac dysfunction, severe hepatic dysfunction, jaundice. Thus, this study assessed the effectiveness of non-anthracycline chemotherapy regimen cyclophosphamide, vincristine, and prednisone (CVP) in elderly DLBCNHL patients vs. the standard CHOP. Methods: This retrospective study included 418 DLBCNHL patients diagnosed between 2003 and 2006 and followed until March 2014. During this period of time, rituximab was not available for all patients, particularly for patients older than 60 years. Results: CHOP and CVP were administered to 351 (84%) and 67 (16%) patients, respectively. Older age and comorbidities, particularly cardiovascular and diabetes mellitus, were independent determinants for not receiving CHOP. Patients received more courses of CHOP treatment than that of CVP (6 vs. 3 courses; P < 0.001) and developed more toxicities (48.4% vs. 23.9%; P < 0.001), particularly fatigue, alopecia, and gastrointestinal tract toxicities. Complete response rate was higher in CHOP than in CVP (69.9% vs. 29.9%; P < 0.001). Moreover, early death was significantly higher in CVP group of patients than in CHOP (43.3% vs. 8.6%; P < 0.001). After a median follow-up of 71 months, the median overall survival (OS) and event-free survival (EFS) were significantly better in CHOP than in CVP (49.5 vs. 3.7 months and 32.2 vs. 3.5 months; P < 0.001 for both, respectively). Older age, poor age-adjusted International Prognostic Index scores, not receiving CHOP or consolidative radiotherapy were independent predictors of poor OS and EFS. Conclusion: Use of the CVP regime to treat DLBCNHL patients who were unfit to the standard CHOP treatment was associated with lower remission rates and poorer EFS and OS in this group of patients.