Contributions
Abstract: S1546
Type: Oral Presentation
Presentation during EHA23: On Sunday, June 17, 2018 from 08:15 - 08:30
Location: Room A1
Background
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma and its incidence rises with increasing age. Several studies have confirmed that rituximab combined with chemotherapy is the best treatment option, but few randomized trials included patients over 80 years of age. Anthracycline-based treatment in combination with rituximab offers a potential cure but comes with substantial risk of adverse events, especially in elderly patients. The treating doctor always has to consider the individual patient’s co-morbidity and risk of complications.
Aims
To use data from the Swedish Lymphoma Registry to compare survival in DLBCL in the very elderly according to treatment intensity.
Methods
The Swedish Lymphoma Registry provided data on diagnosis, clinical factors and therapy and survival status on all patients ≥80 years diagnosed with DLBCL in Sweden 2007 through 2012. To reduce the selection bias that is inherent in retrospective analyses of different therapeutic algorithms, we also compared treatment differences in the Healthcare Regions. We investigated whether regional policy differences correlated with survival in all patients within the Regions (regardless of actual treatment given) using Cox proportional hazards model.
Results
In total 799 patients ≥80 years were identified from the SLR; 47% were male and 53% female. At diagnosis, age-adjusted international prognostic index (aaIPI) ≥ 2 was seen in 49% and bulky disease in 20%. Patients treated with anthracycline-based treatment with curative intention (R-CHOP-21, R-CHOP-14, R-CHOEP) showed significantly better survival with a hazard ratio (HR) of 2.5 (95% confidence interval [CI], 2.2-3.0) compared with patients treated with palliative regimens or no chemotherapy at all. In the Regional analysis, two Regions treated a relatively large proportion of their elderly patients with curative intent (58% in total) whereas three Regions showed a lower fraction (43% in total) and one Region deviated with a considerably low percentage (33%). These treatment differences were highly significant (p<0.001). The overall survival was also significantly better in the more intensive Regions compared with the less intensive and the least intensive Region, HR 1.3 (95% CI 1.1-1.6) and HR 1.5 (95% CI 1.2-1.9)
Conclusion
In this large, nationwide, population-based study we show that anthracycline-based treatment with curative intention is associated with improved survival also in the very elderly patients over 80 years of age. Furthermore, we can show that the proportion of patients treated with curative intention vary between different healthcare Regions in Sweden suggesting different routines when it comes to treating the very elderly. We used the Regional differences to validate our results by showing that Regions with more intensive treatment traditions have better overall survival. This analysis can be seen as a geographic randomization that is unaffected by response to therapy and co-morbidity since the intensity of treatment is significantly differs merely on the basis of region. We conclude that also patients over the age of 80 years benefit from anthracycline-based treatment with curative intention.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): DLBCL, Elderly, Treatment
Abstract: S1546
Type: Oral Presentation
Presentation during EHA23: On Sunday, June 17, 2018 from 08:15 - 08:30
Location: Room A1
Background
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma and its incidence rises with increasing age. Several studies have confirmed that rituximab combined with chemotherapy is the best treatment option, but few randomized trials included patients over 80 years of age. Anthracycline-based treatment in combination with rituximab offers a potential cure but comes with substantial risk of adverse events, especially in elderly patients. The treating doctor always has to consider the individual patient’s co-morbidity and risk of complications.
Aims
To use data from the Swedish Lymphoma Registry to compare survival in DLBCL in the very elderly according to treatment intensity.
Methods
The Swedish Lymphoma Registry provided data on diagnosis, clinical factors and therapy and survival status on all patients ≥80 years diagnosed with DLBCL in Sweden 2007 through 2012. To reduce the selection bias that is inherent in retrospective analyses of different therapeutic algorithms, we also compared treatment differences in the Healthcare Regions. We investigated whether regional policy differences correlated with survival in all patients within the Regions (regardless of actual treatment given) using Cox proportional hazards model.
Results
In total 799 patients ≥80 years were identified from the SLR; 47% were male and 53% female. At diagnosis, age-adjusted international prognostic index (aaIPI) ≥ 2 was seen in 49% and bulky disease in 20%. Patients treated with anthracycline-based treatment with curative intention (R-CHOP-21, R-CHOP-14, R-CHOEP) showed significantly better survival with a hazard ratio (HR) of 2.5 (95% confidence interval [CI], 2.2-3.0) compared with patients treated with palliative regimens or no chemotherapy at all. In the Regional analysis, two Regions treated a relatively large proportion of their elderly patients with curative intent (58% in total) whereas three Regions showed a lower fraction (43% in total) and one Region deviated with a considerably low percentage (33%). These treatment differences were highly significant (p<0.001). The overall survival was also significantly better in the more intensive Regions compared with the less intensive and the least intensive Region, HR 1.3 (95% CI 1.1-1.6) and HR 1.5 (95% CI 1.2-1.9)
Conclusion
In this large, nationwide, population-based study we show that anthracycline-based treatment with curative intention is associated with improved survival also in the very elderly patients over 80 years of age. Furthermore, we can show that the proportion of patients treated with curative intention vary between different healthcare Regions in Sweden suggesting different routines when it comes to treating the very elderly. We used the Regional differences to validate our results by showing that Regions with more intensive treatment traditions have better overall survival. This analysis can be seen as a geographic randomization that is unaffected by response to therapy and co-morbidity since the intensity of treatment is significantly differs merely on the basis of region. We conclude that also patients over the age of 80 years benefit from anthracycline-based treatment with curative intention.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): DLBCL, Elderly, Treatment