Age-dependent increase of treatment-related mortality in older patients with aggressive B cell lymphoma: analysis of outcome, treatment feasibility, and toxicity in 1171 elderly patients with aggressive B cell lymphoma—data from phase II and III trials of the DSHNHL (German High-Grade Non-Hodgkin’s Lymphoma Study Group)
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| Titel: | Age-dependent increase of treatment-related mortality in older patients with aggressive B cell lymphoma: analysis of outcome, treatment feasibility, and toxicity in 1171 elderly patients with aggressive B cell lymphoma—data from phase II and III trials of the DSHNHL (German High-Grade Non-Hodgkin’s Lymphoma Study Group) |
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| Autoren: | Zettl, Florian, Ziepert, Marita, Altmann, Bettina, Zeynalova, Samira, Held, Gerhard, Pöschel, Viola, Hohloch, Karin, Wulf, Gerald G., Glass, Bertram, Schmitz, Norbert, Loeffler, Markus, Trümper, Lorenz, Department of Hematology, Oncology and Palliative Care, Klinikum Traunstein, Traunstein, Germany, Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany, Department of Internal Medicine, University Hospital Saarland, Homburg, Germany, Hematology and Oncology, Kantonsspital Graubünden, Chur, Switzerland, Department of Hematology and Medical Oncology, Georg August University Göttingen, Göttingen, Germany, Department of Hematology, Oncology, and Tumor Immunology, Helios Klinikum Berlin-Buch, Berlin, Germany, Department of Internal Medicine A, University of Münster, Münster, Germany |
| Weitere Verfasser: | Zettl, Florian, Ziepert, Marita, Altmann, Bettina, Zeynalova, Samira, Held, Gerhard, Pöschel, Viola, Hohloch, Karin, Wulf, Gerald G., Glass, Bertram, Schmitz, Norbert, Loeffler, Markus, Trümper, Lorenz, Department of Hematology, Oncology and Palliative Care, Klinikum Traunstein, Traunstein, Germany, Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany, Department of Internal Medicine, University Hospital Saarland, Homburg, Germany, Hematology and Oncology, Kantonsspital Graubünden, Chur, Switzerland, Department of Hematology and Medical Oncology, Georg August University Göttingen, Göttingen, Germany, Department of Hematology, Oncology, and Tumor Immunology, Helios Klinikum Berlin-Buch, Berlin, Germany, Department of Internal Medicine A, University of Münster, Münster, Germany |
| Quelle: | Ann Hematol |
| Verlagsinformationen: | Springer Science and Business Media LLC, 2020. |
| Publikationsjahr: | 2020 |
| Schlagwörter: | Aged, 80 and over, Male, Lymphoma, B-Cell, Dose-Response Relationship, Drug, Age Factors, Kaplan-Meier Estimate, Antibiotic Prophylaxis, Middle Aged, Age Factors [MeSH], Aged, 80 and over [MeSH], Lymphoma, B-Cell/drug therapy [MeSH], Aged [MeSH], Aggressive lymphoma, Prednisone/adverse effects [MeSH], Multicenter Studies as Topic/statistics, Progression-Free Survival [MeSH], Clinical Trials, Phase II as Topic/statistics, Cyclophosphamide/adverse effects [MeSH], Diffuse large cell lymphoma, Feasibility Studies [MeSH], Rituximab/administration, Cyclophosphamide/administration, Original Article, Clinical Trials, Phase III as Topic/statistics, Male [MeSH], Rituximab/adverse effects [MeSH], Doxorubicin/administration, Randomized Controlled Trials as Topic/statistics, Elderly patients, Vincristine/administration, Dose-Response Relationship, Drug [MeSH], Antibiotic Prophylaxis [MeSH], Female [MeSH], Doxorubicin/adverse effects [MeSH], Infections, Kaplan-Meier Estimate [MeSH], Humans [MeSH], Treatment Outcome [MeSH], Retrospective Studies [MeSH], Middle Aged [MeSH], Lymphoma, B-Cell/mortality [MeSH], Treatment-related mortality, Antineoplastic Combined Chemotherapy Protocols/administration, Antineoplastic Combined Chemotherapy Protocols/therapeutic use [MeSH], Prednisone/administration, Antineoplastic Combined Chemotherapy Protocols/adverse effects [MeSH], Vincristine/adverse effects [MeSH], Progression-Free Survival, 3. Good health, 03 medical and health sciences, Clinical Trials, Phase II as Topic, 0302 clinical medicine, Clinical Trials, Phase III as Topic, Doxorubicin, Antineoplastic Combined Chemotherapy Protocols, Feasibility Studies, Humans, Multicenter Studies as Topic, Prednisone, Female, Cyclophosphamide, Aged |
| Beschreibung: | In elderly patients (pts) with aggressive B cell lymphoma (aNHL), curative treatment often cannot be administered because of comorbidities and tolerability. We analyzed the influence of age in pts > 60 years receiving the R-CHOP-14 regimen within different prospective DSHNHL trials. Of the RICOVER-60 trial and CHOP-R-ESC trials, 1171 aNHL pts were included in this retrospective analysis of age-dependent event-free survival (EFS), progression-free survival (PFS), and overall survival (OS). All patients received prophylactic G-CSF, and anti-infective prophylaxis with amphotericin B mouth wash and oral fluorchinolone was optional. In the CHOP-R-ESC trials, prophylaxis was augmented to include mandatory continuous orally administered aciclovir and a pneumocystis prophylaxis with cotrimoxazole as well as oral fluorchinolones during neutropenia. The patient population was separated into 4 age groups (61–65 years, 66–70 years, 71–75 years, and 76–80 years). The results from the RICOVER-60 trial were subsequently confirmed in the following CHOP-R-ESC trials by a multivariate analysis adjusted for IPI factors and gender. Significant differences (p < 0.001) in EFS, PFS, and OS were seen between age groups (RICOVER-60). Hematotoxicity, infections, and TRM increased with age. TRM was significantly elevated in the age group 76–80 years. Therefore, this analysis shows that an age above 75 years defines an especially vulnerable patient population when being treated with chemoimmunotherapy for aNHL. Prophylactic anti-infective drugs are essential and clinically effective in reducing morbidity when treating elderly aNHL pts. |
| Publikationsart: | Article Other literature type |
| Sprache: | English |
| ISSN: | 1432-0584 0939-5555 |
| DOI: | 10.1007/s00277-020-04345-3 |
| Zugangs-URL: | https://link.springer.com/content/pdf/10.1007/s00277-020-04345-3.pdf https://pubmed.ncbi.nlm.nih.gov/33242101 https://link.springer.com/content/pdf/10.1007/s00277-020-04345-3.pdf https://pubmed.ncbi.nlm.nih.gov/33242101/ http://www.ncbi.nlm.nih.gov/pubmed/33242101 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960591 https://link.springer.com/article/10.1007/s00277-020-04345-3 https://resolver.sub.uni-goettingen.de/purl?gro-2/83385 https://repository.publisso.de/resource/frl:6467030 |
| Rights: | CC BY |
| Dokumentencode: | edsair.doi.dedup.....1c24f7f83510175405b3f7e0f63e52e5 |
| Datenbank: | OpenAIRE |
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