PB1798 EFFICACY AND TOLERABILITY OF R‐MINICHOP IMMUNOCHEMOTHERAPY IN ELDERLY PATIENTS WITH HIGH GRADE NON‐HODGKIN LYMPHOMA: REAL WORLD EXPERIENCE AT A RURAL UK HOSPITAL.
Authors: O’Farrell F.M. , Rozi N.R. , Khan D.Z. , Cooke L.J. , Idris S.F. 
Published: June 2019

Background:

The increasing incidence of high grade Non‐Hodgkin Lymphoma in aging populations places a significant burden on healthcare systems. Co‐morbidity, frailty, and reduced organ and physiological reserve contribute to treatment‐related complications. R‐miniCHOP is emerging as the standard of care for these patient with good efficacy and tolerability in clinical trial settings. We reviewed our single centre experience of delivering R‐miniCHOP therapy to elderly patients with high grade lymphoma over a 5 year period in a rural British hospital.

Aims:

We sought to assess the clinical efficacy and tolerability of attenuated immunochemotherapy (R‐miniCHOP) in elderly patients with high grade lymphoma in a ‘real‐world’ setting with medium term follow up of up to 7 years.

Methods:

We conducted a retrospective case review of patients who presented to our haematology service with aggressive non‐Hodgkin lymphoma and received R‐miniCHOP attenuated immunochemotherapy as outpatient therapy between 2012 and 2017. Patients received rituximab (375 mg/m2), cyclophosphamide (400 mg/m2), doxorubicin (25 mg/m2) and vincristine (1 mg/m2) on day 1 of each cycle, and prednisolone (40 mg/m2) on days 1‐5. We examined baseline patient characteristics, ECOG performance status, Ann Arbor stage, serum lactate dehydrogenase (LDH) concentration and International Prognostic Index (IPI) at diagnosis. Furthermore, we undertook a review of interim or post chemo disease response by PET/CT imaging and determined renal, cardiac, hepatic and bone marrow toxicities in all patients with follow up until January 2019. A route cause analysis was undertaken for all patients who had died during the follow‐up period.

Results:

We identified 23 patients treated with R‐miniCHOP between 2012 and 2017. Median age at diagnosis was 82 years (range 74‐88) and 52% were female. Diffuse large B‐cell lymphoma (DLBL) was the most common diagnosis (74%). Mean serum [LDH] at diagnosis was 320U/L (range 162‐1202U/L). Ann Arbor staging and IPI are detailed in Table 1 but patients of all IPI stage were represented in our cohort. The mean number of immunochemotherapy cycles administered was 4 (range 1‐8) and only 3 patients required dose/regimen modifications. Fatigue (52%), peripheral neuropathy (26%), and alopecia (22%) were the most commonly identified toxicities. Two patients (9%) experienced significant cardiotoxicity with echocardiographic evidence of reduced left ventricular ejection fraction. There were no intensive care admissions or deaths related to neutropenic sepsis. Overall, 30% of patients experienced a partial treatment response and a further 39% were in clinical remission at the time of reporting. Ten patients (43%) died over the follow up period, with 5 deaths attributable to disease progression, 1 died of GI bleeding which may have been associated with chemotherapy and the other 4 died of alternative unrelated causes.

Summary/Conclusion:

In our single centre experience at a small rural general hospital, attenuated immunochemotherapy proves an efficacious and generally well‐tolerated treatment regimen for elderly patients with high grade non‐Hodgkin lymphoma and can provide lasting remissions for a substantial number of patients in this age group. These data are broadly in line with a previous phase 2 study of R‐miniCHOP in patients aged over 80 years with DLBL and support the continued use of this regimen in elderly patients with high grade NHL receiving treatment in a variety of settings. (Peyrade et al., Lancet Oncology 2013).

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