Modified chemotherapy treatment offers new treatment option for very old patients with aggressive non-Hodgkin's lymphoma

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Lymphoma in elderly patients is particularly difficult to treat their reduced ability to chemotherapy * tolerate. But a large phase trial, published in the Lancet Oncology 2, reports online first, that a modified approach to handling a reduced dose of conventional chemotherapy with one with standard dose of rituximab in combination well tolerated and showed a clear answer * and improved survival in very elderly patients with diffuse large B cell lymphoma, a common and very aggressive form of non-Hodgkin's lymphoma.

These findings suggest that a majority of patients older than 80 years with diffuse large B cell lymphoma can be cured, and this new regime should be the standard of care in these patients for the first time.

B diffuse-cell lymphoma is a cancer in the elderly, and with the increase in life expectancy of the general population, cases rise set are. In the last decade combining the monoclonal antibody rituximab with the standard chemotherapy of CHOP (doxorubicin, cyclophosphamide, vincristine and prednisone) has improved significantly survival for patients younger than 80 years. However, studies have included not patients over 80 years. A small retrospective study proposed that in patients older than 80 years a reduced dose of standard chemotherapy could increase compatibility while maintaining effectiveness.

In this study a team led by Frédéric Peyrade of Haemato haematology Centre regional de lutte contre le cancer de Nice, Nice, France examined the efficacy and safety of the combination of a low dose of CHOP chemotherapy with a standard dose of rituximab R-MiniCHOP) in patients over 80 years with B cell lymphoma, diffuse. From 2006 to 2009, 150 patients of 38 centers in France and Belgium were enrolled and six cycles of R-MiniCHOP at 3 week intervals.

Response rates achieved were 73% overall, and the full or unconfirmed complete response rate was 62%.

With a median follow-up of 20 months, median overall survival was 29 months and the total was 2-year survival rate of 59%.

The R-MiniCHOP-therapy was well tolerated, so that management of the full planned dose in 72% of patients. The treatment have been attributed to a very small number of hospital admissions and a small number of deaths (12) toxicity.

The authors conclude: "R MiniCHOP offers a good balance of efficacy and safety... and should be the standard treatment for patients older than diffuse reflection 80 years, the large B cell lymphoma and a good performance status".

In a comment, Josep Maria Ribera of the Institut de Recerca contra la previously Josep Carreras, Universitat Autònoma de Barcelona, Spain says: "These findings... offer hope for very old patients with diffuse large B cell lymphoma - a group that is often excluded from clinical trials."

Dr. Ribera adds: "the most important issues for the near future are expanded as these benefits to a wider range of patients and as the effectiveness of this treatment regimen continues to increase."

Notes

* Several factors increase the risk of chemotherapy toxicity in the older including: functional impairment, co-morbidity, chronic malnutrition, cognitive decline, depression, social isolation, impaired bone marrow function and changed metabolism of drugs.

* Response rate is on, the treatment is as effective shrink at the tumor.

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The Lancet Oncology