TY - JOUR
T1 - Treating Diffuse Large B Cell Lymphoma in the Very Old or Frail Patients
AU - Kumar, Abhijeet
AU - Fraz, Muhammad Asad
AU - Usman, Muhammad
AU - Malik, Saad Ullah
AU - Ijaz, Awais
AU - Durer, Ceren
AU - Durer, Seren
AU - Tariq, Muhammad Junaid
AU - Khan, Ali Younas
AU - Qureshi, Anum
AU - Faridi, Warda
AU - Nasar, Aboo
AU - Anwer, Faiz
N1 - Publisher Copyright:
© 2018, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - R-CHOP has been the standard of care for diffuse large B cell lymphoma (DLBCL), curing approximately 60% of patients for more than 2 decades. However, the optimal treatment of patients who are too frail to tolerate this regimen and/or are not candidates for anthracycline therapy continues to be debated. MInT and GELA trials established addition of rituximab to CHOP in DLBCL but excluded patients older than 80 years. Multiple regimens have been tried with varying success in the very elderly, including R-mini-CHOP, R-mini CEOP, R-split CHOP, pre-phase strategies, and R-GCVP. However, there has not been a randomized trial among these strategies. Although addition of novel agents including ibrutinib, brentuximab vedotin, lenalidomide, and many others on the horizon holds promise in this population, none have been tested in a randomized setting or have results awaited. There is also a lack of a validated and easy to use clinical tool in this population to predict patients who will not tolerate R-CHOP. Identifying patients who will not tolerate R-CHOP early with the help of tools like CGA, along with integrating biology-based treatment (ibrutinib, lenalidomide in activated B cell type DLBCL) is being investigated in this population.
AB - R-CHOP has been the standard of care for diffuse large B cell lymphoma (DLBCL), curing approximately 60% of patients for more than 2 decades. However, the optimal treatment of patients who are too frail to tolerate this regimen and/or are not candidates for anthracycline therapy continues to be debated. MInT and GELA trials established addition of rituximab to CHOP in DLBCL but excluded patients older than 80 years. Multiple regimens have been tried with varying success in the very elderly, including R-mini-CHOP, R-mini CEOP, R-split CHOP, pre-phase strategies, and R-GCVP. However, there has not been a randomized trial among these strategies. Although addition of novel agents including ibrutinib, brentuximab vedotin, lenalidomide, and many others on the horizon holds promise in this population, none have been tested in a randomized setting or have results awaited. There is also a lack of a validated and easy to use clinical tool in this population to predict patients who will not tolerate R-CHOP. Identifying patients who will not tolerate R-CHOP early with the help of tools like CGA, along with integrating biology-based treatment (ibrutinib, lenalidomide in activated B cell type DLBCL) is being investigated in this population.
KW - Chemotherapy
KW - Comorbidity
KW - Comprehensive geriatric assessment
KW - Diffuse large B cell lymphoma
KW - Elderly
KW - Frail
KW - R-CHOP
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U2 - 10.1007/s11864-018-0565-6
DO - 10.1007/s11864-018-0565-6
M3 - Review article
AN - SCOPUS:85052748966
SN - 1527-2729
VL - 19
JO - Current Treatment Options in Oncology
JF - Current Treatment Options in Oncology
IS - 10
M1 - 50
ER -