Abstract
Treatment of diffuse large B cell lymphoma (DLBCL) remains challenging in elderly population and systematic reviews are lacking in this area. Medline and Cochrane Register of Controlled Trials in addition to conference proceedings were searched for therapeutic clinical trials on frontline treatment of DLBCL in adults ≥60 in post-rituximab era. Forty-one out of 713 reviewed papers met our inclusion criteria. Six cycles of rituximab, cyclophosphamide, vincristine, prednisone (R-CHOP) administered every 21 d remain the standard treatment for fit elderly, with no role for maintenance rituximab. For individuals ≥80, the strongest evidence favors rituximab/ofatumumab-miniCHOP. Numerous alternative approaches including the use of liposomal anthracyclines, dose and regimen adjustment to frailty/comorbidity score, brief duration regimens, and consolidative radioimmunotherapy have produced promising outcomes and could be considered for R-CHOP inappropriate elderly. Phase III randomized trials studying the efficacy of liposomal vincristine, extended-exposure rituximab, and lenalidomide plus R-CHOP are ongoing.
Keywords:
DLBCL; Diffuse large B cell lymphoma; elderly; post-rituximab; systematic review; therapeutic clinical trials.
MeSH terms
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Age Factors
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Aged
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Aged, 80 and over
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Antibodies, Monoclonal, Murine-Derived / administration & dosage
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Antibodies, Monoclonal, Murine-Derived / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / administration & dosage
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Antineoplastic Combined Chemotherapy Protocols / adverse effects*
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Chemoradiotherapy / adverse effects
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Chemoradiotherapy / methods
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Comorbidity
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Disease-Free Survival
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Dose-Response Relationship, Drug
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Doxorubicin / administration & dosage
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Doxorubicin / adverse effects
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Drug Administration Schedule
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Frail Elderly*
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Frailty / complications*
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Frailty / diagnosis
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Frailty / epidemiology
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Humans
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Lymphoma, Large B-Cell, Diffuse / epidemiology
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Lymphoma, Large B-Cell, Diffuse / therapy*
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Maintenance Chemotherapy / adverse effects
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Maintenance Chemotherapy / methods
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Prednisone / administration & dosage
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Prednisone / adverse effects
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Radioimmunotherapy / methods*
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Randomized Controlled Trials as Topic
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Rituximab / administration & dosage
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Rituximab / adverse effects
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Vincristine / administration & dosage
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Vincristine / adverse effects
Substances
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Antibodies, Monoclonal, Murine-Derived
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R-CHOP protocol
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Rituximab
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Vincristine
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Doxorubicin
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Cyclophosphamide
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Prednisone