Modulated Chemotherapy According to Modified Comprehensive Geriatric Assessment in 100 Consecutive Elderly Patients with Diffuse Large B‐Cell Lymphoma
Learning Objectives: After completing this course, the reader will be able to: Use a modulation of chemotherapy according to modified geriatric assessment to improve outcomes for elderly patients with diffuse large B‐cell lymphoma with an acceptable level of toxicity. Offer elderly patients the best...
Gespeichert in:
| Veröffentlicht in: | The oncologist (Dayton, Ohio) Ohio), 2012-06, Vol.17 (6), p.838-846 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 846 |
|---|---|
| container_issue | 6 |
| container_start_page | 838 |
| container_title | The oncologist (Dayton, Ohio) |
| container_volume | 17 |
| creator | Spina, Michele Balzarotti, Monica Uziel, Lilj Ferreri, Andrés José Marìa Fratino, Lucia Magagnoli, Massimo Talamini, Renato Giacalone, Annalisa Ravaioli, Elena Chimienti, Emanuela Berretta, Massimiliano Lleshi, Arben Santoro, Armando Tirelli, Umberto |
| description | Learning Objectives:
After completing this course, the reader will be able to:
Use a modulation of chemotherapy according to modified geriatric assessment to improve outcomes for elderly patients with diffuse large B‐cell lymphoma with an acceptable level of toxicity.
Offer elderly patients the best tailored treatment while minimizing the dose‐limiting toxicity.
This article is available for continuing medical education credit at CME.TheOncologist.com
Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or deescalate therapy, thereby reducing toxicity, with consequent risks for under‐ or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores.
Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow‐up of 64 months, 51 patients were alive, with 5‐year disease‐free, overall, and cause‐specific survival rates of 80%, 60%, and 74%, respectively.
Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA‐driven treatment may result in better cure rates, especially in fit and unfit patients.
A prospective trial aimed at evaluating the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma was conducted. Chemotherapy adjustments based on a comprehensive geriatric assessment were associated with manageable toxicity and excellent outcomes. |
| doi_str_mv | 10.1634/theoncologist.2011-0417 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3380883</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1551625296</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5048-f54e47883f3bece6de3c1fcc657a4aa86b3940f4539ac2c41a649319e410d97e3</originalsourceid><addsrcrecordid>eNqNks9u1DAQxi0EoqXwCuAjlxQ7dv74ANISSkFaWA4gcbO8zmRj5MTBdlrlxiNw5Pl4EhxtqeiNk8ea33wzo28QekbJOS0ZfxF7cKN21h1MiOc5oTQjnFb30CktuMi4IF_vp5jULKtoIU7QoxC-EZJClj9EJ3le0vThp-jXB9fOVkVocdPD4JKwV9OCN1o735rxgKPDiTGdWRE3TB56GIO5AnwJ3qjojcabECCEAcaIzYgpIYkcA-g5rtyFbcHbBX9S0SQk4GsTe_zGdN0cAG-VPwB-_fvHzwasxdtlmHo3qMfoQadsgCc37xn68vbic_Mu2-4u3zebbaYLwuusKzjwqq5Zx_agoWyBadppXRaV4krV5Z4JTjpeMKF0rjlVJReMCuCUtKICdoZeHXWneT9Aq9OAXlk5eTMov0injLybGU0vD-5KMlaT1DcJPL8R8O77DCHKwQSdVlEjuDlIWhS0zItclAmtjqj2LgQP3W0bSuTqq7zjq1x9lauvqfLpv1Pe1v01MgEvj8C1sbD8r67cfWx26Uhq9ge1t7xQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1551625296</pqid></control><display><type>article</type><title>Modulated Chemotherapy According to Modified Comprehensive Geriatric Assessment in 100 Consecutive Elderly Patients with Diffuse Large B‐Cell Lymphoma</title><source>MEDLINE</source><source>Oxford Journals Open Access Collection</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Wiley Online Library All Journals</source><source>PubMed Central</source><creator>Spina, Michele ; Balzarotti, Monica ; Uziel, Lilj ; Ferreri, Andrés José Marìa ; Fratino, Lucia ; Magagnoli, Massimo ; Talamini, Renato ; Giacalone, Annalisa ; Ravaioli, Elena ; Chimienti, Emanuela ; Berretta, Massimiliano ; Lleshi, Arben ; Santoro, Armando ; Tirelli, Umberto</creator><creatorcontrib>Spina, Michele ; Balzarotti, Monica ; Uziel, Lilj ; Ferreri, Andrés José Marìa ; Fratino, Lucia ; Magagnoli, Massimo ; Talamini, Renato ; Giacalone, Annalisa ; Ravaioli, Elena ; Chimienti, Emanuela ; Berretta, Massimiliano ; Lleshi, Arben ; Santoro, Armando ; Tirelli, Umberto</creatorcontrib><description>Learning Objectives:
After completing this course, the reader will be able to:
Use a modulation of chemotherapy according to modified geriatric assessment to improve outcomes for elderly patients with diffuse large B‐cell lymphoma with an acceptable level of toxicity.
Offer elderly patients the best tailored treatment while minimizing the dose‐limiting toxicity.
This article is available for continuing medical education credit at CME.TheOncologist.com
Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or deescalate therapy, thereby reducing toxicity, with consequent risks for under‐ or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores.
Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow‐up of 64 months, 51 patients were alive, with 5‐year disease‐free, overall, and cause‐specific survival rates of 80%, 60%, and 74%, respectively.
Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA‐driven treatment may result in better cure rates, especially in fit and unfit patients.
A prospective trial aimed at evaluating the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma was conducted. Chemotherapy adjustments based on a comprehensive geriatric assessment were associated with manageable toxicity and excellent outcomes.</description><identifier>ISSN: 1083-7159</identifier><identifier>EISSN: 1549-490X</identifier><identifier>DOI: 10.1634/theoncologist.2011-0417</identifier><identifier>PMID: 22610154</identifier><language>eng</language><publisher>Durham, NC, USA: AlphaMed Press</publisher><subject>Activities of Daily Living ; Aged ; Aged, 80 and over ; Anemia - drug therapy ; Anemia - etiology ; Antibodies, Monoclonal, Murine-Derived - adverse effects ; Antibodies, Monoclonal, Murine-Derived - therapeutic use ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Comprehensive geriatric assessment ; Cyclophosphamide - adverse effects ; Cyclophosphamide - therapeutic use ; Disease-Free Survival ; Doxorubicin - adverse effects ; Doxorubicin - therapeutic use ; Elderly ; Female ; Follow-Up Studies ; Geriatric Assessment - methods ; Geriatric Oncology ; Humans ; Lymphoma, Large B-Cell, Diffuse - drug therapy ; Lymphoma, Large B-Cell, Diffuse - pathology ; Male ; Neutropenia - drug therapy ; Neutropenia - etiology ; Non‐Hodgkin's lymphoma ; Prednisone - adverse effects ; Prednisone - therapeutic use ; Prospective Studies ; Rituximab ; Treatment ; Treatment Outcome ; Vincristine - adverse effects ; Vincristine - therapeutic use</subject><ispartof>The oncologist (Dayton, Ohio), 2012-06, Vol.17 (6), p.838-846</ispartof><rights>2012 AlphaMed Press</rights><rights>AlphaMed Press 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5048-f54e47883f3bece6de3c1fcc657a4aa86b3940f4539ac2c41a649319e410d97e3</citedby><cites>FETCH-LOGICAL-c5048-f54e47883f3bece6de3c1fcc657a4aa86b3940f4539ac2c41a649319e410d97e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380883/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380883/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1417,27924,27925,45574,45575,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22610154$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Spina, Michele</creatorcontrib><creatorcontrib>Balzarotti, Monica</creatorcontrib><creatorcontrib>Uziel, Lilj</creatorcontrib><creatorcontrib>Ferreri, Andrés José Marìa</creatorcontrib><creatorcontrib>Fratino, Lucia</creatorcontrib><creatorcontrib>Magagnoli, Massimo</creatorcontrib><creatorcontrib>Talamini, Renato</creatorcontrib><creatorcontrib>Giacalone, Annalisa</creatorcontrib><creatorcontrib>Ravaioli, Elena</creatorcontrib><creatorcontrib>Chimienti, Emanuela</creatorcontrib><creatorcontrib>Berretta, Massimiliano</creatorcontrib><creatorcontrib>Lleshi, Arben</creatorcontrib><creatorcontrib>Santoro, Armando</creatorcontrib><creatorcontrib>Tirelli, Umberto</creatorcontrib><title>Modulated Chemotherapy According to Modified Comprehensive Geriatric Assessment in 100 Consecutive Elderly Patients with Diffuse Large B‐Cell Lymphoma</title><title>The oncologist (Dayton, Ohio)</title><addtitle>Oncologist</addtitle><description>Learning Objectives:
After completing this course, the reader will be able to:
Use a modulation of chemotherapy according to modified geriatric assessment to improve outcomes for elderly patients with diffuse large B‐cell lymphoma with an acceptable level of toxicity.
Offer elderly patients the best tailored treatment while minimizing the dose‐limiting toxicity.
This article is available for continuing medical education credit at CME.TheOncologist.com
Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or deescalate therapy, thereby reducing toxicity, with consequent risks for under‐ or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores.
Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow‐up of 64 months, 51 patients were alive, with 5‐year disease‐free, overall, and cause‐specific survival rates of 80%, 60%, and 74%, respectively.
Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA‐driven treatment may result in better cure rates, especially in fit and unfit patients.
A prospective trial aimed at evaluating the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma was conducted. Chemotherapy adjustments based on a comprehensive geriatric assessment were associated with manageable toxicity and excellent outcomes.</description><subject>Activities of Daily Living</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anemia - drug therapy</subject><subject>Anemia - etiology</subject><subject>Antibodies, Monoclonal, Murine-Derived - adverse effects</subject><subject>Antibodies, Monoclonal, Murine-Derived - therapeutic use</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Comprehensive geriatric assessment</subject><subject>Cyclophosphamide - adverse effects</subject><subject>Cyclophosphamide - therapeutic use</subject><subject>Disease-Free Survival</subject><subject>Doxorubicin - adverse effects</subject><subject>Doxorubicin - therapeutic use</subject><subject>Elderly</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Geriatric Assessment - methods</subject><subject>Geriatric Oncology</subject><subject>Humans</subject><subject>Lymphoma, Large B-Cell, Diffuse - drug therapy</subject><subject>Lymphoma, Large B-Cell, Diffuse - pathology</subject><subject>Male</subject><subject>Neutropenia - drug therapy</subject><subject>Neutropenia - etiology</subject><subject>Non‐Hodgkin's lymphoma</subject><subject>Prednisone - adverse effects</subject><subject>Prednisone - therapeutic use</subject><subject>Prospective Studies</subject><subject>Rituximab</subject><subject>Treatment</subject><subject>Treatment Outcome</subject><subject>Vincristine - adverse effects</subject><subject>Vincristine - therapeutic use</subject><issn>1083-7159</issn><issn>1549-490X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks9u1DAQxi0EoqXwCuAjlxQ7dv74ANISSkFaWA4gcbO8zmRj5MTBdlrlxiNw5Pl4EhxtqeiNk8ea33wzo28QekbJOS0ZfxF7cKN21h1MiOc5oTQjnFb30CktuMi4IF_vp5jULKtoIU7QoxC-EZJClj9EJ3le0vThp-jXB9fOVkVocdPD4JKwV9OCN1o735rxgKPDiTGdWRE3TB56GIO5AnwJ3qjojcabECCEAcaIzYgpIYkcA-g5rtyFbcHbBX9S0SQk4GsTe_zGdN0cAG-VPwB-_fvHzwasxdtlmHo3qMfoQadsgCc37xn68vbic_Mu2-4u3zebbaYLwuusKzjwqq5Zx_agoWyBadppXRaV4krV5Z4JTjpeMKF0rjlVJReMCuCUtKICdoZeHXWneT9Aq9OAXlk5eTMov0injLybGU0vD-5KMlaT1DcJPL8R8O77DCHKwQSdVlEjuDlIWhS0zItclAmtjqj2LgQP3W0bSuTqq7zjq1x9lauvqfLpv1Pe1v01MgEvj8C1sbD8r67cfWx26Uhq9ge1t7xQ</recordid><startdate>201206</startdate><enddate>201206</enddate><creator>Spina, Michele</creator><creator>Balzarotti, Monica</creator><creator>Uziel, Lilj</creator><creator>Ferreri, Andrés José Marìa</creator><creator>Fratino, Lucia</creator><creator>Magagnoli, Massimo</creator><creator>Talamini, Renato</creator><creator>Giacalone, Annalisa</creator><creator>Ravaioli, Elena</creator><creator>Chimienti, Emanuela</creator><creator>Berretta, Massimiliano</creator><creator>Lleshi, Arben</creator><creator>Santoro, Armando</creator><creator>Tirelli, Umberto</creator><general>AlphaMed Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>H94</scope><scope>5PM</scope></search><sort><creationdate>201206</creationdate><title>Modulated Chemotherapy According to Modified Comprehensive Geriatric Assessment in 100 Consecutive Elderly Patients with Diffuse Large B‐Cell Lymphoma</title><author>Spina, Michele ; Balzarotti, Monica ; Uziel, Lilj ; Ferreri, Andrés José Marìa ; Fratino, Lucia ; Magagnoli, Massimo ; Talamini, Renato ; Giacalone, Annalisa ; Ravaioli, Elena ; Chimienti, Emanuela ; Berretta, Massimiliano ; Lleshi, Arben ; Santoro, Armando ; Tirelli, Umberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5048-f54e47883f3bece6de3c1fcc657a4aa86b3940f4539ac2c41a649319e410d97e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Activities of Daily Living</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anemia - drug therapy</topic><topic>Anemia - etiology</topic><topic>Antibodies, Monoclonal, Murine-Derived - adverse effects</topic><topic>Antibodies, Monoclonal, Murine-Derived - therapeutic use</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Comprehensive geriatric assessment</topic><topic>Cyclophosphamide - adverse effects</topic><topic>Cyclophosphamide - therapeutic use</topic><topic>Disease-Free Survival</topic><topic>Doxorubicin - adverse effects</topic><topic>Doxorubicin - therapeutic use</topic><topic>Elderly</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Geriatric Assessment - methods</topic><topic>Geriatric Oncology</topic><topic>Humans</topic><topic>Lymphoma, Large B-Cell, Diffuse - drug therapy</topic><topic>Lymphoma, Large B-Cell, Diffuse - pathology</topic><topic>Male</topic><topic>Neutropenia - drug therapy</topic><topic>Neutropenia - etiology</topic><topic>Non‐Hodgkin's lymphoma</topic><topic>Prednisone - adverse effects</topic><topic>Prednisone - therapeutic use</topic><topic>Prospective Studies</topic><topic>Rituximab</topic><topic>Treatment</topic><topic>Treatment Outcome</topic><topic>Vincristine - adverse effects</topic><topic>Vincristine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Spina, Michele</creatorcontrib><creatorcontrib>Balzarotti, Monica</creatorcontrib><creatorcontrib>Uziel, Lilj</creatorcontrib><creatorcontrib>Ferreri, Andrés José Marìa</creatorcontrib><creatorcontrib>Fratino, Lucia</creatorcontrib><creatorcontrib>Magagnoli, Massimo</creatorcontrib><creatorcontrib>Talamini, Renato</creatorcontrib><creatorcontrib>Giacalone, Annalisa</creatorcontrib><creatorcontrib>Ravaioli, Elena</creatorcontrib><creatorcontrib>Chimienti, Emanuela</creatorcontrib><creatorcontrib>Berretta, Massimiliano</creatorcontrib><creatorcontrib>Lleshi, Arben</creatorcontrib><creatorcontrib>Santoro, Armando</creatorcontrib><creatorcontrib>Tirelli, Umberto</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The oncologist (Dayton, Ohio)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Spina, Michele</au><au>Balzarotti, Monica</au><au>Uziel, Lilj</au><au>Ferreri, Andrés José Marìa</au><au>Fratino, Lucia</au><au>Magagnoli, Massimo</au><au>Talamini, Renato</au><au>Giacalone, Annalisa</au><au>Ravaioli, Elena</au><au>Chimienti, Emanuela</au><au>Berretta, Massimiliano</au><au>Lleshi, Arben</au><au>Santoro, Armando</au><au>Tirelli, Umberto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Modulated Chemotherapy According to Modified Comprehensive Geriatric Assessment in 100 Consecutive Elderly Patients with Diffuse Large B‐Cell Lymphoma</atitle><jtitle>The oncologist (Dayton, Ohio)</jtitle><addtitle>Oncologist</addtitle><date>2012-06</date><risdate>2012</risdate><volume>17</volume><issue>6</issue><spage>838</spage><epage>846</epage><pages>838-846</pages><issn>1083-7159</issn><eissn>1549-490X</eissn><abstract>Learning Objectives:
After completing this course, the reader will be able to:
Use a modulation of chemotherapy according to modified geriatric assessment to improve outcomes for elderly patients with diffuse large B‐cell lymphoma with an acceptable level of toxicity.
Offer elderly patients the best tailored treatment while minimizing the dose‐limiting toxicity.
This article is available for continuing medical education credit at CME.TheOncologist.com
Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or deescalate therapy, thereby reducing toxicity, with consequent risks for under‐ or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores.
Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow‐up of 64 months, 51 patients were alive, with 5‐year disease‐free, overall, and cause‐specific survival rates of 80%, 60%, and 74%, respectively.
Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA‐driven treatment may result in better cure rates, especially in fit and unfit patients.
A prospective trial aimed at evaluating the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment in elderly (aged ≥70 years) patients with diffuse large B‐cell lymphoma was conducted. Chemotherapy adjustments based on a comprehensive geriatric assessment were associated with manageable toxicity and excellent outcomes.</abstract><cop>Durham, NC, USA</cop><pub>AlphaMed Press</pub><pmid>22610154</pmid><doi>10.1634/theoncologist.2011-0417</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1083-7159 |
| ispartof | The oncologist (Dayton, Ohio), 2012-06, Vol.17 (6), p.838-846 |
| issn | 1083-7159 1549-490X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3380883 |
| source | MEDLINE; Oxford Journals Open Access Collection; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals; PubMed Central |
| subjects | Activities of Daily Living Aged Aged, 80 and over Anemia - drug therapy Anemia - etiology Antibodies, Monoclonal, Murine-Derived - adverse effects Antibodies, Monoclonal, Murine-Derived - therapeutic use Antineoplastic Combined Chemotherapy Protocols - adverse effects Antineoplastic Combined Chemotherapy Protocols - therapeutic use Comprehensive geriatric assessment Cyclophosphamide - adverse effects Cyclophosphamide - therapeutic use Disease-Free Survival Doxorubicin - adverse effects Doxorubicin - therapeutic use Elderly Female Follow-Up Studies Geriatric Assessment - methods Geriatric Oncology Humans Lymphoma, Large B-Cell, Diffuse - drug therapy Lymphoma, Large B-Cell, Diffuse - pathology Male Neutropenia - drug therapy Neutropenia - etiology Non‐Hodgkin's lymphoma Prednisone - adverse effects Prednisone - therapeutic use Prospective Studies Rituximab Treatment Treatment Outcome Vincristine - adverse effects Vincristine - therapeutic use |
| title | Modulated Chemotherapy According to Modified Comprehensive Geriatric Assessment in 100 Consecutive Elderly Patients with Diffuse Large B‐Cell Lymphoma |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-08T00%3A41%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Modulated%20Chemotherapy%20According%20to%20Modified%20Comprehensive%20Geriatric%20Assessment%20in%20100%20Consecutive%20Elderly%20Patients%20with%20Diffuse%20Large%20B%E2%80%90Cell%20Lymphoma&rft.jtitle=The%20oncologist%20(Dayton,%20Ohio)&rft.au=Spina,%20Michele&rft.date=2012-06&rft.volume=17&rft.issue=6&rft.spage=838&rft.epage=846&rft.pages=838-846&rft.issn=1083-7159&rft.eissn=1549-490X&rft_id=info:doi/10.1634/theoncologist.2011-0417&rft_dat=%3Cproquest_pubme%3E1551625296%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1551625296&rft_id=info:pmid/22610154&rfr_iscdi=true |