Is bendamustine-rituximab a reasonable treatment in selected older patients with diffuse large B cell lymphoma? Results from a multicentre, retrospective study

  • Vanja ZeremskiEmail author
  • Kathleen Jentsch-Ullrich
  • Christoph Kahl
  • Martin Mohren
  • Judith Eberhardt
  • Thomas Fischer
  • Enrico Schalk
Original Article


Despite bendamustine-rituximab (BR) showed disappointing efficacy in diffuse large B cell lymphoma (DLBCL), it is still occasionally used as first-line treatment in older DLBCL patients instead of recommended R-CHOP. This multicentre, retrospective study was aimed to clarify circumstances in which BR may be justified in this setting. Patients ≥ 65 years with ECOG performance status (PS) ≥ 2 or ≥ 75 years regardless of PS were included. A total of 140 patients were analysed (BR, 68; R-CHOP, 72). BR patients were older (p < 0.001) and were diagnosed more often with high-risk disease (p = 0.03); no difference regarding comorbidities or PS was seen. Compared with R-CHOP, BR was associated with marked inferior overall survival (OS) (16.3 vs. 75.4 months; p = 0.006) and progression-free survival (PFS) (11.0 vs. 62.3 months; p < 0.001). In multivariate analysis, only high age-adjusted Charlson Comorbidity Index (aaCCI) was associated with inferior PFS in R-CHOP patients (hazard ratio 2.67; p = 0.012). Comparing the subgroup of BR and R-CHOP patients with high aaCCI, there was no difference in OS (p = 0.73) or PFS (p = 0.75). Due to the observed non-superiority of R-CHOP in older DLBCL patients with comorbidities, we propose that this subgroup may be treated alternatively with BR, whereas all other older patients are clearly R-CHOP candidates.


Diffuse large B cell lymphoma Bendamustine R-CHOP Older patients Comorbidities 


Conflict of interest

The authors declare that they have no conflict of interest.

Funding information

This research was supported by a grant from the German Research Foundation (DFG; SFB854).

Compliance with ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Haematology and OncologyOtto-von-Guericke University MagdeburgMagdeburgGermany
  2. 2.Health Campus Immunology, Infectiology and Inflammation (GC-I3), Medical CentreOtto-von-Guericke UniversityMagdeburgGermany
  3. 3.Private Practice for Haematology and OncologyMagdeburgGermany
  4. 4.Department of Haematology, Oncology and Palliative CareKlinikum MagdeburgMagdeburgGermany
  5. 5.Department of Hematology and OncologyJohanniter KrankenhausStendalGermany

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