Treating Diffuse Large B Cell Lymphoma in the Very Old or Frail Patients

Current Treatment Options in Oncology
Abhijeet KumarFaiz Anwer

Abstract

R-CHOP has been the standard of care for diffuse large B cell lymphoma (DLBCL), curing approximately 60% of patients for more than 2 decades. However, the optimal treatment of patients who are too frail to tolerate this regimen and/or are not candidates for anthracycline therapy continues to be debated. MInT and GELA trials established addition of rituximab to CHOP in DLBCL but excluded patients older than 80 years. Multiple regimens have been tried with varying success in the very elderly, including R-mini-CHOP, R-mini CEOP, R-split CHOP, pre-phase strategies, and R-GCVP. However, there has not been a randomized trial among these strategies. Although addition of novel agents including ibrutinib, brentuximab vedotin, lenalidomide, and many others on the horizon holds promise in this population, none have been tested in a randomized setting or have results awaited. There is also a lack of a validated and easy to use clinical tool in this population to predict patients who will not tolerate R-CHOP. Identifying patients who will not tolerate R-CHOP early with the help of tools like CGA, along with integrating biology-based treatment (ibrutinib, lenalidomide in activated B cell type DLBCL) is being investigated in this population.

References

Jan 25, 2002·The New England Journal of Medicine·Bertrand CoiffierChristian Gisselbrecht
Jun 21, 2002·The New England Journal of Medicine·Andreas RosenwaldUNKNOWN Lymphoma/Leukemia Molecular Profiling Project
Nov 11, 2003·Critical Reviews in Oncology/hematology·Jeffrey C Delafuente
Nov 25, 2004·Hematology·Richard I FisherOwen A O'Connor
May 4, 2005·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·P FeugierB Coiffier
Jun 16, 2005·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Laurie H SehnJoseph M Connors
Aug 9, 2005·Critical Reviews in Oncology/hematology·Martine ExtermannUNKNOWN Task Force on CGA of the International Society of Geriatric Oncology
May 10, 2007·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Martine Extermann, Arti Hurria
Dec 11, 2007·Annals of Oncology : Official Journal of the European Society for Medical Oncology·C ThieblemontB Coiffier
Jan 30, 2008·The Lancet Oncology·Michael PfreundschuhUNKNOWN German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL)
Oct 20, 2010·Annals of Oncology : Official Journal of the European Society for Medical Oncology·M AaproU Wedding
Apr 13, 2011·The Lancet Oncology·Frédéric PeyradeUNKNOWN Groupe d'Etude des Lymphomes de l'Adulte (GELA) investigators
Jan 13, 2012·Blood·Wolfram KlapperUNKNOWN Molecular Mechanisms in Malignant Lymphomas Network Project of the Deutsche Krebshilfe
May 2, 2012·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Kevin S Scher, Arti Hurria
Aug 1, 2012·The Lancet Oncology·Frédéric PeyradeAntoine Thyss
Aug 24, 2013·Annals of Oncology : Official Journal of the European Society for Medical Oncology·A TrebouetR Houot
Dec 4, 2013·Blood·Michael PfreundschuhNiels Murawski
Mar 13, 2014·European Journal of Haematology·Stephan KreherClaudia D Baldus
Aug 20, 2014·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Grzegorz S NowakowskiThomas E Witzig
Nov 19, 2014·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Michael PfreundschuhNiels Murawski
Feb 24, 2015·Clinical Lymphoma, Myeloma & Leukemia·Christine C DavisChristopher R Flowers
May 21, 2015·American Society of Clinical Oncology Educational Book·Grzegorz S Nowakowski, Myron S Czuczman
Jan 9, 2016·CA: a Cancer Journal for Clinicians·Rebecca L SiegelAhmedin Jemal
Aug 4, 2016·Annals of Hematology·Kamel LaribiAlix Baugier de Materre
Sep 13, 2016·CA: a Cancer Journal for Clinicians·Lauren R TerasChristopher R Flowers
Oct 11, 2017·British Journal of Haematology·Michael PfreundschuhCarsten Zwick

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