Retrospective Review of Treatment Patterns and Outcomes of DLBCL in the Very Elderly: A Single Centre Experience
Notice bibliographique
Résumé
Treatment of diffuse large B-cell lymphoma (DLBCL) in patients over the age of 80 years is challenging due to existing comorbidities and frailty in the face of an aggressive disease. Standard chemo-immunotherapy can sometimes be difficult to administer to these patients due to toxicities, requiring dose adjustments and interruptions. There are no definitive guidelines to help direct therapy in these patients and treatment decisions are often subjective. The objective of this study was to retrospectively review treatment patterns and outcomes of DLBCL in patients over the age of 80 years. All patients who were referred to the Tom Baker Cancer Centre in Calgary, Alberta from 2012-2017 were retrospectively reviewed. Data collected included patient characteristics, comorbidities that were used to calculate the Charlson Comorbidity Index (CCI), revised International Prognostic Index (IPI), chemotherapy regimen(s), dose reductions and interruptions, and mortality. The primary outcome was overall survival (OS). A total of 123 patients with DLBCL over the age of 80 were referred to the cancer center at diagnosis. The average age was 84.9 years (IQR 82-87.5). At diagnosis, 62.3% of patients had an ECOG≥2 and 65.8% of patients had an IPI greater than 3. The most common comorbidities described were a history of congestive heart failure (20%), diabetes (16%) and MI (20%). Patients received either curative intent chemotherapy (62.6%) or palliative therapy (37.4%). The curative intent chemotherapy regimens included dose-reduced R-CHOP (31.5%), full dose R-CHOP (11.8%), R-CEOP (14.2%), and other chemotherapy regimens (3.9%). Palliative therapy included PEP-C chemotherapy (4.7%) or treatment with steroids (13.4%) or no treatment at all (20.5%). There were 28 patients (22.7%) who received adjunctive radiotherapy for limited stage or bulky disease. Risk factors at diagnosis for mortality included elevated LDH (OR 3.14, CI 1.42-6.93, p<0.05) and ECOG≥2 (OR 2.15, 0.99-4.67, p<0.05). Every 1 point increase in patients' CCI at diagnosis was associated with an increased risk of death (OR 1.38, 95% CI 1.05-1.82, p=0.02). The cumulative OS at 2 years was 44.7%. Patients who received any amount of curative intent chemotherapy did better than the palliative group (See Figure 1). Within the chemotherapy group, 33.3% of patients stopped their treatment early. These patients had better survival than the palliation group (HR 0.56, 95% CI 0.34-0.94, p=0.04) but overall still had a poor prognosis with a median OS of 10.9 months. Very elderly patients with DLBCL still remain a very challenging population to treat with most patients presenting with high risk disease and poor functional status. Without chemotherapy, the overall prognosis is dismal. Patients who are able to complete treatment with chemo-immunotherapy have the best survival despite the risk of toxicities associated with more intensive treatment but that survival is significantly shortened if they are unable to complete their planned cycles. Disclosures Owen: AbbVie, F. Hoffmann-La Roche, Janssen, Astrazeneca, Merck, Servier, Novartis, Teva: Honoraria.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».