Serum Albumin Levels Strongly Predict Survival Outcome of Elderly Patients with Diffuse Large B-Cell Lymphoma Treated with Rituximab-Combined Chemotherapy
Background: In the current Japanese aging society, a high number of very elderly patients (age ranged from 80 to 93) with diffuse large B-cell lymphoma (DLBCL, most frequent hematological malignancy), who require chemotherapy are encountered. However, standard chemotherapy can result in severe adverse effects in elderly patients. Although various scoring systems are available to assess frailty, they are too complicated to immediately make a therapeutic decision, and studies on indications for chemotherapy in elderly patients are few.
Materials and Methods: In the present study, we retrospectively analyzed the clinical records of 56 patients with DLBCL aged 80 or older who received R-CHOP or similar chemotherapy. Association of various clinical parameters, including performance status, stage, B symptom(s), laboratory data and relative dose intensity and survival outcomes was examined.
Results: Pretreatment serum albumin level was identified as the only factor that predicts overall and progression-free survivals.
Conclusion: We have concluded that very elderly DLBCL patients aged 80 or older with hypoalbuminemia may be unfit for standard chemotherapy, regardless of other factors. Alternative or palliative therapy should be considered for those patients.
2. Varga C, Holcroft C, Kezouh A, et al. Comparison of outcomes among patients aged 80 and over and younger patients with diffuse large B-cell lymphoma: a population based study. Leuk Lymphoma. 2014; 55(3): 533-7.
3. Charlson ME, Pompei P, Ales JK, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5): 373-83.
4. Laribi K, Denizon N, Bolle D, et al. R-CVP regimen is active in frail elderly patients aged 80 or over with diffuse large B cell lymphoma. Ann Hematol; 2016. 95(10): 1705-14.
5. Chihara D, Westin JR, Oki Y, et al. Management strategies and outcomes for very elderly patients with diffuse large B-cell lymphoma. Cancer. 2016; 122(20): 3145-51.
6. Miura K, Konishi J, Miyake T, et al. A Host-Dependent Prognostic Model for Elderly Patients with Diffuse Large B-Cell Lymphoma. Oncologist. 2017; 22(5): 554-560.
7. Hamaker ME, Jonker JM, de Rooij SE, et al. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systemic review. Lancet Oncol. 2012; 13(10): e437-44.
8. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969; 9(3): 179-86.
9. Mori M, Kitamura K, Masuda M, et al. Long-term results of a multicenter randomized, comparative trial of modified CHOP, versus THP-COP versus THP-COPE regimens in elderly patients with non-Hodgkin’s lymphoma. Int J Hematol. 2005; 81(3): 246-54.
10. Swerdlow SH, Campo E, Harris NL, et al. The 2008 WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon, France: International Agency for Research on Cancer; 2008.
11. International non-Hodgkin’s lymphoma prognostic factors project. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1993; 329(14): 987-94.
12. Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced international prognostic index (NCCN-IPI) for patients with diffuse large B-cell lymphoma. Treated in the rituximab era. Blood. 2014;123(6): 837-42.
13. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013; 48(3): 452-8.
14. Cheson BD, Horning SJ, Coiffier B, et al. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 1999; 17(4): 1244.
15. Cheson BD, Pfistner B, Juweid ME, et al. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007; 25(5): 579-86.
16. Iioka F, Izumi K, Kamada Y, et al. Outcomes of very elderly patients with aggressive B-cell non-Hodgkin lymphoma treated with reduced-dose chemotherapy. Int J Clin Oncol. 2016; 21(3): 498-505.
17. Peyrade F, Jardin F, Thieblemont C, et al. Attenuated immunochemotherapy regimen (R-miniCHOP) in elderly patients older than 80 years with diffuse large B-cell lymphoma: a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2011; 12(5): 460-8.
18. Dalia S, Chavez J, Little B, et al. Serum albumin retains independent prognostic significance in diffuse large B-cell lymphoma in the post-rituximab era. Ann Hematol. 2014; 93(8): 1305-12.
19. Bairey O, Shacham-Abulafia A, Shpilberg O, et al. Serum albumin level at diagnosis of diffuse large B-cell lymphoma: an important simple prognostic factor. Hematol Oncol. 2016; 34(4): 184-192.
20. Ochi Y, Kazuma Y, Hiramoto N, et al. Utility of a simple prognostic stratification based on platelet counts and serum albumin levels in elderly patients with diffuse large B cell lymphoma. Ann Hematol. 2017. 96(1): 1-8.
21. Kobayashi T, Kuroda J, Yokota I, et al. The Kyoto Prognostic Index for patients with Diffuse Large B-cell Lymphoma in the Rituximab era. Blood Cancer J. 2016; 6(1):e383.
22. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004; 17(6): 432-7.
23. Van der Poel MW, Mulder WJ, Ossenkoppele GJ, et al. Factors that influence treatment decision-making in elderly DLBCL patients: a case vignette study. Ann Hematol. 2015; 94(8): 1373-9.
|Issue||Vol 16, No 1 (2022)|
|Diffuse large B-cell lymphoma; Elderly; Rituximab combined cyclophosphamide; Doxorubicin; Vincristine and prednisolone (R-CHOP); Albumin|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|