Comparison between R-COMP and R-CHOP in Older Patients with Diffuse Large B-Cell Lymphoma (DLBCL): A Substudy of the Elderly Project By the Fondazione Italiana Linfomi
Authors: Merli Francesco , Spina Michele , Tucci Alessandra , Rigacci Luigi , Cavallo Federica , Cabras Maria Giuseppina , Alvarez Isabel , Fabbri Alberto , Re Alessandro , Puccini Benedetta , Ferrero Simone , Usai Sara Veronica , Ferrari Angela , Cencini Emanuele , Pennese Elsa , Zilioli Vittorio Ruggero , Marino Dario , Balzarotti Monica , Cox M. Christina , Zanni Manuela , Di Rocco Alice , Lleshi Arben , Botto Barbara , Hohaus Stefan , Merli Michele , Sartori Roberto , Gini Guido , Nassi Luca , Musuraca Gerardo , Tani Monica , Bottelli Chiara , Kovalchuk Sofia , Re Francesca , Flenghi Leonardo , Molinari Anna Lia , Tarantini Giuseppe , Chimienti Emanuela , Marcheselli Luigi , Mammi Caterina , Luminari Stefano , Arcari Annalisa 
Published: November 2021

Abstract
Introduction
Non-pegylated liposomal doxorubicin (NPLD) is considered a good alternative to conventional doxorubicin for the treatment of older patients (pts) with aggressive lymphomas and/or at high risk for cardiological toxicity. The use of R-COMP for the treatment of older pts with DLBCL has been supported by several small retrospective studies . In this report we describe the characteristics and outcomes of pts who were prospectively enrolled in the Elderly Project (EP) and who were treated with R-COMP and compared them with pts treated with conventional R-CHOP.
Methods. This analysis was conducted starting from the dataset of the EP study. The use of NPLD was allowed according to 648/96 law, treatment decision was left to physician discretion and was independent of frailty status. For the purposes of this analysis, we included all pts who were treated with full doses of R-CHOP and R-COMP. The study endpoint were progression free survival (PFS) and overall survival (OS). A propensity score analysis was conducted to account for the main confounding factors.
Results
Overall 691 out of 1163 pts of the EP were treated with R-CHOP (383; 55%) or R-COMP (308; 45%); median age was 71 and 76 years for R-CHOP and R-COMP, respectively (p &lt; 0.001) (Table 1). Pts were similarly distributed among different IPI groups for R-COMP or R-CHOP. Based on simplified Geriatric Assessment (sGA) 88%, 11% and &lt;1% of the R-CHOP treated pts and 61%, 32% and 6% of the R-COMP pts were FIT, UNFIT, and FRAIL (p &lt;0.001). Elderly Prognostic Index (EPI) score was low, intermediate, and high in 39%, 54% and 8% of R-CHOP pts and 27%, 49% and 24% of R-COMP pts (p &lt;0.001). PFS at 3-years was 70% for R-CHOP and 64% for R-COMP (p=ns). OS at 3-years was 77% for R-CHOP and 71% for R-COMP (p=ns). The propensity score analysis was conducted in 610 pts and confirmed no significant differences in terms of PFS and OS in the comparison between R-CHOP and R-COMP treated pts (PFS; HR 1.17, 95% CI 0.84-1.63; OS: HR 1.04 95% CI 0.64-1.48). No differences were registered in terms of interruption of treatment due to toxicities (7% for R-CHOP and 11% for R-COMP).
Conclusions
Data from the prospective observational EP study did not show significant differences in terms of efficacy comparing R-COMP to standard R-CHOP. The higher frequency of UNFIT and FRAIL pts among those treated with NPLD suggests R-COMP is a good strategy to offer a curative treatment to these groups of pts.
Figure 1 Figure 1.

Disclosures
Merli: EUSA Pharma: Other: Travel, Accomodations, Expenses; Roche: Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accomodations, Expenses; Takeda: Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accomodations, Expenses; MSD: Membership on an entity's Board of Directors or advisory committees; Gilead Science: Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accomodations, Expenses; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accomodations, Expenses; Celgene: Other: Travel, Accomodations, Expenses. Tucci: janssen: Membership on an entity's Board of Directors or advisory committees; Gentili: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees. Rigacci: Merck: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accomodations, Expenses; Gilead Science: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Menarini: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Cavallo: ROCHE: Membership on an entity's Board of Directors or advisory committees; Servier: Speakers Bureau; Gilead: Speakers Bureau. Fabbri: Servier/Pfizer: Honoraria; Takeda: Other: Travel, Accomodations, Expenses; Takeda: Honoraria. Puccini: Takeda: Membership on an entity's Board of Directors or advisory committees. Ferrero: Incyte: Membership on an entity's Board of Directors or advisory committees; Morphosys: Research Funding; Gilead: Research Funding, Speakers Bureau; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; EUSA Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Servier: Speakers Bureau; Clinigen: Membership on an entity's Board of Directors or advisory committees. Zilioli: Roche, Italfarmaco: Consultancy, Honoraria; MSD, Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accommodations; Gentili, Takeda, Gilead, Servier: Consultancy, Speakers Bureau; Takeda: Other: travel expenses, accommodation. Nassi: Takeda: Consultancy; Kyowa Kirin: Consultancy; Incyte: Consultancy; Roche: Consultancy. Musuraca: Janssen, Incyte, Roche: Consultancy; Janssen, Roche, Incyte: Membership on an entity's Board of Directors or advisory committees; Janssen, Roche, Incyte: Honoraria. Flenghi: Janssen: Other: Travel, Accomodations, Expenses; Roche: Other: Travel, Accomodations, Expenses. Marcheselli: sandoz: Membership on an entity's Board of Directors or advisory committees. Luminari: Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Accomodations, Expenses; Janssen: Other: Travel, Accomodations, Expenses; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Regeneron: Consultancy; GENELAB SRL: Consultancy.