Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma

Kenneth R. Carson, Peter Riedell, Ryan Lynch, Chadi Nabhan, Tanya M. Wildes, Weijian Liu, Arun Ganti, Ryan Roop, Kristen M. Sanfilippo, Katiuscia O'Brian, Jingxia Liu, Nancy L. Bartlett, Amanda Cashen, Nina Wagner-Johnston, Todd A. Fehniger, Graham A. Colditz

Research output: Contribution to journalArticle

Abstract

Objectives: While anthracycline-based treatment can cure diffuse large B-cell lymphoma, most patients over age 80 do not receive doxorubicin due to toxicity concerns. This study evaluated this practice, as patients age 80 and older are largely excluded from clinical trials. The primary outcome of interest was overall survival. Secondary outcomes included treatment-related mortality and anthracycline dose intensity. Materials and Methods: We assembled a cohort of 530 newly diagnosed diffuse large B-cell lymphoma patients age 80 or older diagnosed within United States Veterans Health Administration. Treatment and survival information were obtained to determine associations between anthracycline use, dose intensity, treatment-related mortality and overall survival. Results: Of the 530 patients, 285 received systemic treatment and 193 received an anthracycline. After controlling for potential confounders, rituximab decreased mortality (hazard ratio, 0.62; 95% confidence interval [CI]: 0.44-0.88), while doxorubicin was not significantly associated with mortality (hazard ratio, 0.87; 95% CI: 0.64-1.17). Completion of treatment with anthracycline dose intensity ≥ 85% of expected was only 14%. Patients treated with anthracycline dose intensity <85% had better one year survival compared to those treated at ≥ 85% (70% vs. 59%, p = 0.029). Conclusion: These results suggest that full dose anthracycline therapy may be less important in the treatment of diffuse large B-cell lymphoma patients over age 80. The low frequency of completion of full dose intensity treatment suggests that standard doses are an unrealistic standard of care for patients this age. Alternate treatment strategies and risk stratification should be considered for these patients.

Original languageEnglish (US)
Pages (from-to)211-218
Number of pages8
JournalJournal of Geriatric Oncology
Volume6
Issue number3
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Lymphoma, Large B-Cell, Diffuse
Anthracyclines
Veterans
Drug Therapy
Therapeutics
Survival
Mortality
Doxorubicin
Confidence Intervals
Veterans Health
United States Department of Veterans Affairs
Standard of Care
Clinical Trials

Keywords

  • Doxorubicin
  • Elderly
  • Lymphoma
  • Veterans

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Oncology

Cite this

Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma. / Carson, Kenneth R.; Riedell, Peter; Lynch, Ryan; Nabhan, Chadi; Wildes, Tanya M.; Liu, Weijian; Ganti, Arun; Roop, Ryan; Sanfilippo, Kristen M.; O'Brian, Katiuscia; Liu, Jingxia; Bartlett, Nancy L.; Cashen, Amanda; Wagner-Johnston, Nina; Fehniger, Todd A.; Colditz, Graham A.

In: Journal of Geriatric Oncology, Vol. 6, No. 3, 01.05.2015, p. 211-218.

Research output: Contribution to journalArticle

Carson, KR, Riedell, P, Lynch, R, Nabhan, C, Wildes, TM, Liu, W, Ganti, A, Roop, R, Sanfilippo, KM, O'Brian, K, Liu, J, Bartlett, NL, Cashen, A, Wagner-Johnston, N, Fehniger, TA & Colditz, GA 2015, 'Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma', Journal of Geriatric Oncology, vol. 6, no. 3, pp. 211-218. https://doi.org/10.1016/j.jgo.2015.01.003
Carson, Kenneth R. ; Riedell, Peter ; Lynch, Ryan ; Nabhan, Chadi ; Wildes, Tanya M. ; Liu, Weijian ; Ganti, Arun ; Roop, Ryan ; Sanfilippo, Kristen M. ; O'Brian, Katiuscia ; Liu, Jingxia ; Bartlett, Nancy L. ; Cashen, Amanda ; Wagner-Johnston, Nina ; Fehniger, Todd A. ; Colditz, Graham A. / Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma. In: Journal of Geriatric Oncology. 2015 ; Vol. 6, No. 3. pp. 211-218.
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abstract = "Objectives: While anthracycline-based treatment can cure diffuse large B-cell lymphoma, most patients over age 80 do not receive doxorubicin due to toxicity concerns. This study evaluated this practice, as patients age 80 and older are largely excluded from clinical trials. The primary outcome of interest was overall survival. Secondary outcomes included treatment-related mortality and anthracycline dose intensity. Materials and Methods: We assembled a cohort of 530 newly diagnosed diffuse large B-cell lymphoma patients age 80 or older diagnosed within United States Veterans Health Administration. Treatment and survival information were obtained to determine associations between anthracycline use, dose intensity, treatment-related mortality and overall survival. Results: Of the 530 patients, 285 received systemic treatment and 193 received an anthracycline. After controlling for potential confounders, rituximab decreased mortality (hazard ratio, 0.62; 95{\%} confidence interval [CI]: 0.44-0.88), while doxorubicin was not significantly associated with mortality (hazard ratio, 0.87; 95{\%} CI: 0.64-1.17). Completion of treatment with anthracycline dose intensity ≥ 85{\%} of expected was only 14{\%}. Patients treated with anthracycline dose intensity <85{\%} had better one year survival compared to those treated at ≥ 85{\%} (70{\%} vs. 59{\%}, p = 0.029). Conclusion: These results suggest that full dose anthracycline therapy may be less important in the treatment of diffuse large B-cell lymphoma patients over age 80. The low frequency of completion of full dose intensity treatment suggests that standard doses are an unrealistic standard of care for patients this age. Alternate treatment strategies and risk stratification should be considered for these patients.",
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T1 - Comparative effectiveness of anthracycline-containing chemotherapy in United States veterans age 80 and older with diffuse large B-cell lymphoma

AU - Carson, Kenneth R.

AU - Riedell, Peter

AU - Lynch, Ryan

AU - Nabhan, Chadi

AU - Wildes, Tanya M.

AU - Liu, Weijian

AU - Ganti, Arun

AU - Roop, Ryan

AU - Sanfilippo, Kristen M.

AU - O'Brian, Katiuscia

AU - Liu, Jingxia

AU - Bartlett, Nancy L.

AU - Cashen, Amanda

AU - Wagner-Johnston, Nina

AU - Fehniger, Todd A.

AU - Colditz, Graham A.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Objectives: While anthracycline-based treatment can cure diffuse large B-cell lymphoma, most patients over age 80 do not receive doxorubicin due to toxicity concerns. This study evaluated this practice, as patients age 80 and older are largely excluded from clinical trials. The primary outcome of interest was overall survival. Secondary outcomes included treatment-related mortality and anthracycline dose intensity. Materials and Methods: We assembled a cohort of 530 newly diagnosed diffuse large B-cell lymphoma patients age 80 or older diagnosed within United States Veterans Health Administration. Treatment and survival information were obtained to determine associations between anthracycline use, dose intensity, treatment-related mortality and overall survival. Results: Of the 530 patients, 285 received systemic treatment and 193 received an anthracycline. After controlling for potential confounders, rituximab decreased mortality (hazard ratio, 0.62; 95% confidence interval [CI]: 0.44-0.88), while doxorubicin was not significantly associated with mortality (hazard ratio, 0.87; 95% CI: 0.64-1.17). Completion of treatment with anthracycline dose intensity ≥ 85% of expected was only 14%. Patients treated with anthracycline dose intensity <85% had better one year survival compared to those treated at ≥ 85% (70% vs. 59%, p = 0.029). Conclusion: These results suggest that full dose anthracycline therapy may be less important in the treatment of diffuse large B-cell lymphoma patients over age 80. The low frequency of completion of full dose intensity treatment suggests that standard doses are an unrealistic standard of care for patients this age. Alternate treatment strategies and risk stratification should be considered for these patients.

AB - Objectives: While anthracycline-based treatment can cure diffuse large B-cell lymphoma, most patients over age 80 do not receive doxorubicin due to toxicity concerns. This study evaluated this practice, as patients age 80 and older are largely excluded from clinical trials. The primary outcome of interest was overall survival. Secondary outcomes included treatment-related mortality and anthracycline dose intensity. Materials and Methods: We assembled a cohort of 530 newly diagnosed diffuse large B-cell lymphoma patients age 80 or older diagnosed within United States Veterans Health Administration. Treatment and survival information were obtained to determine associations between anthracycline use, dose intensity, treatment-related mortality and overall survival. Results: Of the 530 patients, 285 received systemic treatment and 193 received an anthracycline. After controlling for potential confounders, rituximab decreased mortality (hazard ratio, 0.62; 95% confidence interval [CI]: 0.44-0.88), while doxorubicin was not significantly associated with mortality (hazard ratio, 0.87; 95% CI: 0.64-1.17). Completion of treatment with anthracycline dose intensity ≥ 85% of expected was only 14%. Patients treated with anthracycline dose intensity <85% had better one year survival compared to those treated at ≥ 85% (70% vs. 59%, p = 0.029). Conclusion: These results suggest that full dose anthracycline therapy may be less important in the treatment of diffuse large B-cell lymphoma patients over age 80. The low frequency of completion of full dose intensity treatment suggests that standard doses are an unrealistic standard of care for patients this age. Alternate treatment strategies and risk stratification should be considered for these patients.

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KW - Elderly

KW - Lymphoma

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