One in 45 older patients treated with immunochemotherapy for diffuse large B-cell lymphoma (DLBCL) die during the first month of treatment, and 25 percent are hospitalized, according to a retrospective study published in the Journal of the National Comprehensive Cancer Network, putting them at a significant risk for treatment-related morbidity and mortality.
Adam Olszewski, MD, an assistant professor at Brown University, and authors attempted to quantify this risk and identify factors associated with mortality and serious morbidity during the first cycle of immunochemotherapy, with the goal of improving preventive interventions.
Data were collected from the Surveillance, Epidemiology and End Results (SEER) registry for 5,530 patients (median age = 76 years) who were ≥65 years old, had Medicare claims, were diagnosed with DLBCL between 2003 and 2011, and received rituximab-based immunochemotherapy (defined as R-CHOP–like, consisting of rituximab, cyclophosphamide, and vincristine in combination with doxorubicin, mitoxantrone, or etoposide). Sixty-six percent of patients were treated with granulocyte colony-stimulating factor (G-CSF) during the first treatment cycle.
The cumulative incidence of death was 2.2 percent (95% CI 1.8-2.6) at 30 days after chemotherapy initiation and 10.9 percent (95% CI 10.1-11.8) at 180 days after chemotherapy initiation.
Factors associated with an increased risk of early mortality included age ≥75 years, lymphoma-related symptoms, chronic kidney disease, poor performance status, use of mobility aids, hospitalization within the past year, and upper endoscopy within the past year. Patients with one or more of these risk factors (56% of patients) had a low risk of early mortality (0.6%), compared with those with four or more risk factors (6% of patients; risk of early mortality = 8.3%).
The cumulative incidence of hospitalization in the first 30 days was 23.5 percent (95% CI 22.4-24.6), with the highest frequency occurring at day eight.
Source: Olszewski AJ, Mantripragada KC, Castillo JJ. Risk factors for early death after rituximab-based immunochemotherapy in older patients with diffuse large B-cell lymphoma. J Natl Compr Canc Netw. 2016;14:1121-29.