Cancer Chemotherapy and Pharmacology

, Volume 84, Issue 1, pp 127–137 | Cite as

Clinical characteristics, treatment patterns and outcomes of patients older than 80 years diagnosed with DLBCL in China over a 10-year period

  • Zhan Shi
  • Xi TangEmail author
  • Qianwen Shen
  • Jiayan Chen
  • Fei Liu
  • Xi Chen
  • Jingwen Wang
  • Jie Zhuang
Original Article



The treatment strategy for elderly patients older than 80 years with DLBCL has not been defined yet because of poor treatment tolerability and lack of data. The aim of this trial was to retrospectively investigate clinical characteristics, treatment patterns and outcomes of patients older than 80 years diagnosed with DLBCL in China over a 10-year period.


This trial comprised 57 patients, aged ≥ 80 years, who were initial diagnosed as diffuse large B-cell lymphoma from 2007 to 2017. They received at least four cycles of reduced-dose R-CHOP21 (Rituximab 375 mg/m2 day 0, Cyclophosphamide 400 mg/m2 day1, Epirubicin 35 mg/m2 day 1, Vincristine 1 mg day 1, and Prednisone 50 mg/m2 days 1–5). An observational population-based, cohort study was performed.


The median age was 82.5 years (range 80–90 years ) and the overall response rate was 73.7%. With a median 36.4-month follow-up, 2-year overall survival (OS) and 2-year progression-free survival were 74.3% and 70.9%, respectively. Using rigorous multivariate analysis, we concluded that NCCN-IPI ≥ 5 was the only predictive poor prognostic factor.


High response rate was concluded on very elderly DLBCL patients (≥ 80 years old) with reduced-dose R-CHOP. However, the very elderly patients with NCCN-IPI score ≥ 5 would lead to poor outcome.


Diffuse large B-cell lymphoma Very elderly Aged R-CHOP 



We want to express great thanks for guidance of the editorial assistance from Prof. Bao zhijun, the director of the department of science and education of Shanghai Hua’Dong Hospital, PRC.


Shanghai Key Laboratory of Clinical Geriatric Medicine (No. 13DZ2260700). Research Center on Aging and Medicine, Fudan University and Shanghai Key Developing Disciplines Program (No. 2015ZB0501).

Compliance with ethical standards

Conflicts of interest

There is no conflict of interest by any of the authors.


  1. 1.
    Yancik R, Ries LA (2004) Cancer in older persons: an international issue in an aging world. Semin Oncol 31:128–136. CrossRefGoogle Scholar
  2. 2.
    Coiffier B, Thieblemont C, Van Den Neste E, Lepeu G, Plantier I, Castaigne S et al (2010) Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: a study by the Grouped’Etudes des Lymphomes de l’Adulte. Blood 116:2040–2045. CrossRefGoogle Scholar
  3. 3.
    Harris NL, Jaffe ES, Diebold J et al (1999) World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 17:3835–3849. CrossRefGoogle Scholar
  4. 4.
    Reuben DB et al (1997) Correlates of hypoalbuminemia in community-dwelling older persons. Am J Clin Nutr 66:38–45. CrossRefGoogle Scholar
  5. 5.
    The International Non-Hodgkin’s Lymphoma Prognostic Factors Project (1993) A predictive model for aggressive non-Hodkin’s lymphoma. N Engl J Med 329:987–994. CrossRefGoogle Scholar
  6. 6.
    Advani RH, Chen H, Habermann TM et al (2010) Comparison of conventional prognostic indices in patients older than 60 years with diffuse large B-cell lymphoma treated with R-CHOP in the US Intergroup Study (ECOG 4494, CALGB 9793): consideration of age greater than 70 years in an elderly prognostic index (E-IPI). Br J Haematol 151:143–151. CrossRefGoogle Scholar
  7. 7.
    Prochazka V, Pytlik R, Janikova A et al (2014) A new prognostic score for elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: the prognostic role of blood monocyte and lymphocyte counts is absent. PLoS ONE 9:e102594. CrossRefGoogle Scholar
  8. 8.
    Zhou Z, Sehn LH, Rademaker AW et al (2014) An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood 123:837–842. CrossRefGoogle Scholar
  9. 9.
    Ziepert M, Schmits R, Trumper L et al (2008) Prognostic factors for hematotoxicity of chemotherapy in aggressive non-Hodgkin’s lymphoma. Ann Oncol 19:752–762. CrossRefGoogle Scholar
  10. 10.
    Johnson NA, Slack GW, Savage KJ et al (2012) Concurrent expression of MYC and BCL2 in diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Clin Oncol 30:3452–3459. CrossRefGoogle Scholar
  11. 11.
    Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V et al (2008) A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc 56:1926–1931. CrossRefGoogle Scholar
  12. 12.
    Eyre TA, Salisbury R, Eyre DW et al (2016) Results of a large retrospective analysis of the effect of intended dose intensity of R-CHOP on outcome in a cohort of consecutive, unselected elderly patients with de novo diffuse large B cell lymphoma. Br J Haematol 173:487–491. CrossRefGoogle Scholar
  13. 13.
    Carson KR, Riedell P, Lynch R et al (2015) Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma. J Geriatr Oncol 6:211–218. CrossRefGoogle Scholar
  14. 14.
    Morrison VA, Hamlin P, Soubeyran P, Stauder R, Wadhwa P, Aapro M et al (2015) Approach to therapy of diffuse large B-cell lymphoma in the elderly: the International Society of Geriatric Oncology (SIOG) expert position commentary. Ann Oncol 26:1058–1068. CrossRefGoogle Scholar
  15. 15.
    Hainsworth JD, Flinn IW, Spigel DR, Clark BL, Griner PL, Vazquez ER et al (2010) Brief-duration rituximab/chemotherapy followed by maintenance rituximab in patients with diffuse large B-cell lymphoma who are poor candidates for R-CHOP chemotherapy: a phase II trial of the Sarah Cannon Oncology Research Consortium. Clin Lymphoma Myeloma Leuk 10:44–50. CrossRefGoogle Scholar
  16. 16.
    Meguro A et al (2012) Rituximab plus 70% cyclophosphamide, doxorubicin, vincristine and prednisone for Japanese patients with diffuse large B-cell lymphoma aged 70 years and older. Leuk Lymphoma 53:43–49. CrossRefGoogle Scholar
  17. 17.
    Weidmann E, Neumann A, Fauth F, Atmaca A, Al-Batran SE, Pauligk C et al (2011) Phase II study of bendamustine in combination with rituximab as first-line treatment in patients 80 years or older with aggressive B-cell lymphomas. Ann Oncol 22:1839–1844. CrossRefGoogle Scholar
  18. 18.
    Fields PA, Townsend W, Webb A et al (2014) De novo treatment of diffuse large B-cell lymphoma with rituximab, cyclophosphamide, vincristine, gemcitabine, and prednisolone in patients with cardiac comorbidity: a United Kingdom National Cancer Research Institute trial. J Clin Oncol 32:282–287. CrossRefGoogle Scholar
  19. 19.
    Peyrade F, Jardin F, Thieblemont C, Thyss A, Emile JF, Castaigne S et al (2011) Attenuated immunochemotherapy regimen (R-miniCHOP) in elderly patients older than 80 years with diffuse large B-cell lymphoma: a multicentre, single-arm, phase 2 trial. Lancet Oncol 12:460–468. CrossRefGoogle Scholar
  20. 20.
    Musolino A, Boggiani D, Panebianco M, Vasini G, Salvagni S, Franciosi V et al (2011) Activity and safety of dose-adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor-prognostic untreated diffuse large B-cell non-Hodgkin lymphoma. Cancer 117:964–973. CrossRefGoogle Scholar
  21. 21.
    Osby E, Hagberg H, Kvaloy S, Teerenhovi L, Anderson H, Cavallin-Stahl E et al (2003) CHOP is superior to CNOP in elderly patients with aggressive lymphoma while outcome is unaffected by filgrastim treatment: results of a Nordic Lymphoma Group randomized trial. Blood 101:3840–3848. CrossRefGoogle Scholar
  22. 22.
    Bessell EM, Burton A, Haynes AP, Glaholm J, Child JA, Cullen MH et al (2003) A randomized multicentre trial of modifed CHOP versus MCOP in patients aged 65 years and over with aggressive non-Hodgkin’s lymphoma. Ann Oncol 14:258–267. CrossRefGoogle Scholar
  23. 23.
    Hryniuk WM, Goodyear M (1990) The calculation of received dose intensity. J Clin Oncol 8:1935–1937. CrossRefGoogle Scholar
  24. 24.
    Cheson BD, Pfistner B, Juweid ME et al (2007) Revised response criteria for malignant lymphoma. J Clin Oncol 25:579–586. CrossRefGoogle Scholar
  25. 25.
    Lyman GH, Dale DC, Friedberg J et al (2004) Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin’s lymphoma: a nationwide study. J Clin Oncol 22:4302–4311. CrossRefGoogle Scholar
  26. 26.
    Dixon DO, Neilan B, Jones SE et al (1986) Effect of age on therapeutic outcome in advanced diffuse histiocytic lymphoma: the Southwest Oncology Group experience. J Clin Oncol 4:295–305. CrossRefGoogle Scholar
  27. 27.
    Balducci L, Repetto L (2004) Increased risk of myelotoxicity in elderly patients with non-Hodkgin lymphoma. Cancer 100:6–11. CrossRefGoogle Scholar
  28. 28.
    Trotti A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13:176–181. CrossRefGoogle Scholar
  29. 29.
    Lichtman SM (2004) Chemotherapy in the elderly. Semin Oncol 31:160–174. CrossRefGoogle Scholar
  30. 30.
    Choi JH et al (2018) Multicenter retrospective analysis of clinical characteristics, treatment patterns, and outcomes in very elderly patients with diffuse large B-cell lymphoma: the Korean Cancer Study Group LY16-01. Cancer Res Treat 50:590–598. CrossRefGoogle Scholar
  31. 31.
    Delarue R, Tilly H, Mounier N, Salles G, Thieblemont C, Bologna S et al (2013) Dose-dense rituximab-CHOP compared with standard rituximab-CHOP in elderly patients with diffuse large B-cell lymphoma (the LNH03-6B study): a randomised phase 3 trial. Lancet Oncol 14:525–533. CrossRefGoogle Scholar
  32. 32.
    Doorduijn JK, van der Holt B, van Imhoff GW et al (2003) CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin’s lymphoma. J Clin Oncol 21:3041–3050. CrossRefGoogle Scholar
  33. 33.
    Pfreundschuh M, Schubert J, Ziepert M, Schmits R, Mohren M, Lengfelder et al (2008) Six versus eight cycles of bi-weekly CHOP-14 with or without rituximab in elderly patients with aggressive CD20 + B-cell lymphomas: a randomised controlled trial (RICOVER-60). Lancet Oncol 9:105–116. CrossRefGoogle Scholar
  34. 34.
    Peters FP, Lalisang RI, Fickers MM et al (2001) Treatment of elderly patients with intermediate- and high-grade non-Hodgkin’s lymphoma: a retrospective population-based study. Ann Hematol 80:155–159. CrossRefGoogle Scholar
  35. 35.
    Pfreundschuh M (2010) How I treat elderly patients with diffuse large B-cell lymphoma. Blood 116:5103–5110. CrossRefGoogle Scholar
  36. 36.
    Trebouet A, Marchand T, Lemal R et al (2013) Lymphoma occurring in patients over 90 years of age: characteristics, outcomes, and prognostic factors: a retrospective analysis of 234 cases from the LYSA. Ann Oncol 24:2612–2618. CrossRefGoogle Scholar
  37. 37.
    Peyrade F, Bologna S, Delwail V et al (2017) Combination of ofatumumab and reduced-dose CHOP for diffuse large B-cell lymphomas in patients aged 80 years or older: an open-label, multicentre, single-arm, phase 2 trial from the LYSA group. Lancet Haematol 4:e46–e55. CrossRefGoogle Scholar
  38. 38.
    Shi Z, Tang X, Wang J et al (2016) Rituximab plus reduced-dose cyclophosphamide, doxorubicin, vincristine and prednisone (RD R-CHOP) chemotherapy is feasible for very elderly patients (≥ 80 years) with B-cell lymphoma: analysis of treatment outcome. J Chemother 28:487–493. CrossRefGoogle Scholar
  39. 39.
    Mora O, Zucca E (2007) Management of elderly patients with hematological neoplasms. Ann Oncol 18(Suppl 1):i49–i53. CrossRefGoogle Scholar
  40. 40.
    Salvi F, Miller MD, Grilli A, Giorgi R, Towers AL, Morichi V et al (2008) A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. J Am Geriatr Soc 56:1926–1931. CrossRefGoogle Scholar
  41. 41.
    Wedding U, Roehrig B, Klippstein A, Steiner P, Schaeffer T, Pientka L et al (2007) Comorbidity in patients with cancer: prevalence and severity measured by cumulative illness rating scale. Crit Rev Oncol Hematol 61:269–276. CrossRefGoogle Scholar
  42. 42.
    Soubeyran P, Fonck M, Blanc-Bisson C et al (2012) Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol 30:1829–1834. CrossRefGoogle Scholar
  43. 43.
    Jung YH, Woo IS, Han CW (2015) Clinical characteristics and outcomes in diffuse large B cell lymphoma patients aged 70 years and older: a single-center experience with a literature review. Korean J Intern Med 30:684–693. CrossRefGoogle Scholar
  44. 44.
    Miura K, Kobayashi Y, Hojo A et al (2011) Attenuated immunochemotherapy for diffuse large B-cell lymphoma. Lancet Oncol 12:725–726. CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Medical OncologyHua’Dong Hospital Affiliated to Fudan UniversityShanghaiChina
  2. 2.Department of Radiation OncologyHua’Dong Hospital Affiliated to Fudan UniversityShanghaiChina

Personalised recommendations