Doxorubicin-based chemotherapy for diffuse large B-cell lymphoma in elderly patients: comparison of treatment outcomes between young and elderly patients and the significance of doxorubicin dosage

Abstract

Background: Although many studies of elderly patients with non-Hodgkin lymphoma have focused on the dose intensity of chemotherapy, few studies have restricted the histologic inclusion criteria such that only patients with diffuse large B-cell lymphoma (DLCL) are considered. In the current study, treatment outcomes for elderly patients (age > or = 60 years) were analyzed, with emphasis on the dose intensity of doxorubicin.

Methods: Between 1994 and 2000, 195 patients with DLCL were treated initially with doxorubicin-based chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone; or cyclophosphamide, vincristine, bleomycin, doxorubicin, procarbazine, and prednisone). Of these patients, 70 were aged 60 years or older.

Results: Elderly patients had poorer treatment outcomes than did young patients (5-year survival, 30% vs. 57%; P < 0.001); however, elderly patients who received doxorubicin at dose intensities > or = 10 mg/m2 per week (n = 25) had outcomes (5-year survival, 52%) that were comparable to those of young patients. Among prognostic factors, only International Prognostic Index score (P = 0.022) and dose intensity of doxorubicin (P = 0.039) were found to have significant effects on the overall survival of elderly patients. When the reasons for doxorubicin dose reduction in 45 elderly patients who ultimately received doxorubicin at dose intensities < 10 mg/m2 per week were analyzed, it was found that 20 patients received reduced doses from the start of treatment because of their old age alone; these dose reductions in the 20 cases resulted in poorer treatment outcomes.

Conclusions: Elderly patients with DLCL who received doxorubicin at dose intensities > or = 10 mg/m2 per week had treatment outcomes that were comparable to those of young patients; however, physician bias associated with patient age was found to be related to unnecessary dose reductions. Efforts to maintain doxorubicin dose intensities > or = 10 mg/m2 per week and more objective standards for the selection of elderly patients capable of tolerating doxorubicin-based regimens are required.