Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older: A Danish population-based cohort study

Maja Bech Juul; Pernille Hammershoej Jensen; Henriette Engberg; Sonja Wehberg; Andriette Dessau-Arp; Donika Haziri; Helene Bjoerg Kristensen; Joachim Baech; Lene Schurmann; Michael Roost Clausen; Rebecca Valentin; Lene Meldgaard Knudsen; Lars Munksgaard; Tarec Christoffer El-Galaly; Henrik Frederiksen; Thomas Stauffer Larsen

doi:10.1016/j.ejca.2018.05.006

Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older: A Danish population-based cohort study

Maja Bech Juul^*, Pernille Hammershoej Jensen, Henriette Engberg, Sonja Wehberg, Andriette Dessau-Arp, Donika Haziri, Helene Bjoerg Kristensen, Joachim Baech, Lene Schurmann, Michael Roost Clausen, Rebecca Valentin, Lene Meldgaard Knudsen, Lars Munksgaard, Tarec Christoffer El-Galaly, Henrik Frederiksen, Thomas Stauffer Larsen

^*Corresponding author for this work

Department of Clinical Medicine

30 Citations (Scopus)

Abstract

Background: Optimal treatment strategy for the oldest patients with diffuse large B-cell lymphoma (DLBCL) remains controversial, as this group often is precluded from clinical trials, and population-based studies are limited. Methods: All Danish DLBCL-patients ≥75 years diagnosed from 2003 to 2012 were identified, using the Danish National Lymphoma Registry (LYFO). Information regarding baseline characteristics, treatment, comorbidities and outcomes was retrieved from LYFO, the Danish National health registries and medical records. Patients were stratified by age (75–79; 80–84 and 85 + years), comorbidity score and treatment modality (standard treatment [R-CHOP/CHOP-like], less intensive regimens or palliative treatment). Findings: A total of 1011 patients were included. Standard treatment was initiated in 64%, ranging from 83% among patients aged 75–79 years to 32% among patient aged 85 + years. With standard treatment, median overall survival (OS) estimates were 4·6, 2·6, and 1·9 years for the age groups 75–79, 80–84 and 85+ years. Among patient aged 75–79 and 80–84 years, OS was superior with standard treatment, although high comorbidity scores attenuated this association. Among patients aged 85+ years, survival was not influenced by treatment intensity. Patients ≥80 years had similar OS regardless of intended (R-)CHOP dosing, whereas patients of 75–79 years scheduled for full dose had higher OS. Standard treatment was not associated with increased hospitalisation. Interpretation: Standard treatment is feasible with good outcomes in a large proportion of elderly DLBCL-patients. Planned dose reduction in patients aged ≥80 years had no negative impact on OS.

Original language	English
Journal	European Journal of Cancer
Volume	99
Pages (from-to)	86-96
Number of pages	11
ISSN	0959-8049
DOIs	https://doi.org/10.1016/j.ejca.2018.05.006
Publication status	Published - 2018

Keywords

Chemotherapy
Comorbidity and treatment
DLBCL
Elderly
R-CHOP

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Juul, M. B., Jensen, P. H., Engberg, H., Wehberg, S., Dessau-Arp, A., Haziri, D., Kristensen, H. B., Baech, J., Schurmann, L., Clausen, M. R., Valentin, R., Knudsen, L. M., Munksgaard, L., El-Galaly, T. C., Frederiksen, H., & Larsen, T. S. (2018). Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older: A Danish population-based cohort study. European Journal of Cancer, 99, 86-96. https://doi.org/10.1016/j.ejca.2018.05.006

Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older: A Danish population-based cohort study. / Juul, Maja Bech; Jensen, Pernille Hammershoej; Engberg, Henriette et al.
In: European Journal of Cancer, Vol. 99, 2018, p. 86-96.

Research output: Contribution to journal › Journal article › Research › peer-review

Juul, MB, Jensen, PH, Engberg, H, Wehberg, S, Dessau-Arp, A, Haziri, D, Kristensen, HB, Baech, J, Schurmann, L, Clausen, MR, Valentin, R, Knudsen, LM, Munksgaard, L, El-Galaly, TC, Frederiksen, H & Larsen, TS 2018, 'Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older: A Danish population-based cohort study', European Journal of Cancer, vol. 99, pp. 86-96. https://doi.org/10.1016/j.ejca.2018.05.006

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title = "Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older: A Danish population-based cohort study",

abstract = "Background: Optimal treatment strategy for the oldest patients with diffuse large B-cell lymphoma (DLBCL) remains controversial, as this group often is precluded from clinical trials, and population-based studies are limited. Methods: All Danish DLBCL-patients ≥75 years diagnosed from 2003 to 2012 were identified, using the Danish National Lymphoma Registry (LYFO). Information regarding baseline characteristics, treatment, comorbidities and outcomes was retrieved from LYFO, the Danish National health registries and medical records. Patients were stratified by age (75–79; 80–84 and 85 + years), comorbidity score and treatment modality (standard treatment [R-CHOP/CHOP-like], less intensive regimens or palliative treatment). Findings: A total of 1011 patients were included. Standard treatment was initiated in 64%, ranging from 83% among patients aged 75–79 years to 32% among patient aged 85 + years. With standard treatment, median overall survival (OS) estimates were 4·6, 2·6, and 1·9 years for the age groups 75–79, 80–84 and 85+ years. Among patient aged 75–79 and 80–84 years, OS was superior with standard treatment, although high comorbidity scores attenuated this association. Among patients aged 85+ years, survival was not influenced by treatment intensity. Patients ≥80 years had similar OS regardless of intended (R-)CHOP dosing, whereas patients of 75–79 years scheduled for full dose had higher OS. Standard treatment was not associated with increased hospitalisation. Interpretation: Standard treatment is feasible with good outcomes in a large proportion of elderly DLBCL-patients. Planned dose reduction in patients aged ≥80 years had no negative impact on OS.",

keywords = "Chemotherapy, Comorbidity and treatment, DLBCL, Elderly, R-CHOP",

author = "Juul, {Maja Bech} and Jensen, {Pernille Hammershoej} and Henriette Engberg and Sonja Wehberg and Andriette Dessau-Arp and Donika Haziri and Kristensen, {Helene Bjoerg} and Joachim Baech and Lene Schurmann and Clausen, {Michael Roost} and Rebecca Valentin and Knudsen, {Lene Meldgaard} and Lars Munksgaard and El-Galaly, {Tarec Christoffer} and Henrik Frederiksen and Larsen, {Thomas Stauffer}",

year = "2018",

doi = "10.1016/j.ejca.2018.05.006",

language = "English",

volume = "99",

pages = "86--96",

journal = "European Journal of Cancer",

issn = "0959-8049",

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TY - JOUR

T1 - Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older

T2 - A Danish population-based cohort study

AU - Juul, Maja Bech

AU - Jensen, Pernille Hammershoej

AU - Engberg, Henriette

AU - Wehberg, Sonja

AU - Dessau-Arp, Andriette

AU - Haziri, Donika

AU - Kristensen, Helene Bjoerg

AU - Baech, Joachim

AU - Schurmann, Lene

AU - Clausen, Michael Roost

AU - Valentin, Rebecca

AU - Knudsen, Lene Meldgaard

AU - Munksgaard, Lars

AU - El-Galaly, Tarec Christoffer

AU - Frederiksen, Henrik

AU - Larsen, Thomas Stauffer

PY - 2018

Y1 - 2018

N2 - Background: Optimal treatment strategy for the oldest patients with diffuse large B-cell lymphoma (DLBCL) remains controversial, as this group often is precluded from clinical trials, and population-based studies are limited. Methods: All Danish DLBCL-patients ≥75 years diagnosed from 2003 to 2012 were identified, using the Danish National Lymphoma Registry (LYFO). Information regarding baseline characteristics, treatment, comorbidities and outcomes was retrieved from LYFO, the Danish National health registries and medical records. Patients were stratified by age (75–79; 80–84 and 85 + years), comorbidity score and treatment modality (standard treatment [R-CHOP/CHOP-like], less intensive regimens or palliative treatment). Findings: A total of 1011 patients were included. Standard treatment was initiated in 64%, ranging from 83% among patients aged 75–79 years to 32% among patient aged 85 + years. With standard treatment, median overall survival (OS) estimates were 4·6, 2·6, and 1·9 years for the age groups 75–79, 80–84 and 85+ years. Among patient aged 75–79 and 80–84 years, OS was superior with standard treatment, although high comorbidity scores attenuated this association. Among patients aged 85+ years, survival was not influenced by treatment intensity. Patients ≥80 years had similar OS regardless of intended (R-)CHOP dosing, whereas patients of 75–79 years scheduled for full dose had higher OS. Standard treatment was not associated with increased hospitalisation. Interpretation: Standard treatment is feasible with good outcomes in a large proportion of elderly DLBCL-patients. Planned dose reduction in patients aged ≥80 years had no negative impact on OS.

AB - Background: Optimal treatment strategy for the oldest patients with diffuse large B-cell lymphoma (DLBCL) remains controversial, as this group often is precluded from clinical trials, and population-based studies are limited. Methods: All Danish DLBCL-patients ≥75 years diagnosed from 2003 to 2012 were identified, using the Danish National Lymphoma Registry (LYFO). Information regarding baseline characteristics, treatment, comorbidities and outcomes was retrieved from LYFO, the Danish National health registries and medical records. Patients were stratified by age (75–79; 80–84 and 85 + years), comorbidity score and treatment modality (standard treatment [R-CHOP/CHOP-like], less intensive regimens or palliative treatment). Findings: A total of 1011 patients were included. Standard treatment was initiated in 64%, ranging from 83% among patients aged 75–79 years to 32% among patient aged 85 + years. With standard treatment, median overall survival (OS) estimates were 4·6, 2·6, and 1·9 years for the age groups 75–79, 80–84 and 85+ years. Among patient aged 75–79 and 80–84 years, OS was superior with standard treatment, although high comorbidity scores attenuated this association. Among patients aged 85+ years, survival was not influenced by treatment intensity. Patients ≥80 years had similar OS regardless of intended (R-)CHOP dosing, whereas patients of 75–79 years scheduled for full dose had higher OS. Standard treatment was not associated with increased hospitalisation. Interpretation: Standard treatment is feasible with good outcomes in a large proportion of elderly DLBCL-patients. Planned dose reduction in patients aged ≥80 years had no negative impact on OS.

KW - Chemotherapy

KW - Comorbidity and treatment

KW - DLBCL

KW - Elderly

KW - R-CHOP

U2 - 10.1016/j.ejca.2018.05.006

DO - 10.1016/j.ejca.2018.05.006

M3 - Journal article

C2 - 29935491

AN - SCOPUS:85048707250

SN - 0959-8049

VL - 99

SP - 86

EP - 96

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -

Treatment strategies and outcomes in diffuse large B-cell lymphoma among 1011 patients aged 75 years or older: A Danish population-based cohort study

Abstract

Keywords

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