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BACKGROUND: The increasing incidence of DLBCL in aging populations places a significant burden on healthcare systems. Co-morbidity, frailty, and reduced organ and physiological reserve contribute to treatment-related complications. The optimal dose intensity of R-CHOP to optimise outcome across different ages with variable frailty and comorbidity burden is unclear OBJECTIVES AND METHODS: We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and co-morbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across 8 UK centres (2009-2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. RESULTS: PFS and OS were significantly inferior in patients ≥80 versus 70-79 years (p<0.001). In contrast, 2-year cumulative relapse incidence, when accounting for non-relapse mortality as a competing risk, was no different between 70-79 versus ≥80 years (p=0.27) or comorbidity status (CIRS-G:0-6 vs >6) (p=0.27). In 70-79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (p<0.001) compared to IDI<80%. Conversely, in patients ≥80 years, there was no difference in PFS (p=0.88) or OS (p=0.75) according to IDI<80% versus ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70-79 years with an IDI<80% (vs. >80%) (p=0.04) but not for patients ≥80 years comparing IDI (p=0.32) CONCLUSION: 'R-mini-CHOP' provides adequate lymphoma-specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure. This article is protected by copyright. All rights reserved.

Original publication

DOI

10.1111/joim.12889

Type

Journal article

Journal

J Intern Med

Publication Date

27/02/2019