Aggressive Lymphoma (Diffuse Large B-Cell and Other Aggressive B-Cell Non-Hodgkin Lymphomas)—
Results from Retrospective/Observational Studies: Outcomes Of Lymphoma In The Elderly
Tove Wästerlid, et al.
The Abstract concludes: We demonstrate relatively encouraging overall survival data for very elderly patients from a real-world setting. Our data indicate that active treatment may be feasible also for some of the very elderly patients with lymphoma, especially among patients with aggressive lymphomas such as DLBCL. This study represents the largest cohort of its kind and this type of population based data may be useful to inform and improve clinical lymphoma management in this age group. Updated data including relative survival, comorbidity and addition of patients aged ≥85 from the Danish lymphoma register will be available and presented by the time of the ASH meeting.
Nicolas Martinez-Calle, et al.
The Abstract concludes: MTX can be delivered to the majority of pts >70 years with manageable TRM rates. Notably, early treatment discontinuation was relatively frequent with outcomes in this group comparable to palliative care. By contrast, pts who completed >3 cycles of HI-MTX and underwent consolidation experienced comparable outcomes to younger trial cohorts. MTX combination chemotherapy and MTX dose intensity were the strongest predictors of survival whilst rituximab was not a covariate for response or survival despite an increase in its use. Maximising cumulative MTX dose, particularly within more intensive protocols, may translate into improved ORR and survival in older pts with PCNSL.
573 Impact of Intended and Relative Dose Intensity of RCHOP in a Large, Consecutive Cohort of Elderly DLBCL Patients: No Difference in DFS for 70-80 Years Versus >80 Years and Idi Independently Predicts Survival
Toby A. Eyre, et al.
The Abstract concludes: To our knowledge, this is the largest series that has systematically analysed RDI, IDI (DOX, CYCLO and combination) and co-morbidities in consecutive unselected DLBCL ≥70y. Consistent with recent literature (Juul et al, 2018), there is no clear benefit to PFS, DFS or OS in dose intensifying (IDI>80) in ≥80y. IDI is a clear independent predictor of outcome across all pts. Pts 70-80y with IDI <80 were less fit (higher ECOG and CIRS-G) which may have limited IDI and RDI. DFS did not significantly differ by 70-80y vs ≥80y suggesting systemic PD does not fully account for inferior PFS and OS in ≥80y.
Alessia Castellino, et al.
The Abstract concludes: VR DLBCL is a rare disease, which can occur as primary, concurrent with systemic, or in relapsed disease. OS over the decades has significantly improved. In PVRL, no late CNS relapses were observed, while late intraocular relapses can occur. A combined approach with intraocular + systemic HD-MTX based treatment at diagnosis was associated with a higher FFS and CNS-relapse free survival in PVRL and is recommended in bilateral involvement, even though no differences in OS were observed. Treatment consolidation with ASCT can be considered in cases with concurrent systemic disease. Further studies are needed to confirm these results and to better define the role of new drugs in treatment of this uncommon malignancy.
Madison Keenan, et al.
The Abstract concludes: Very elderly (≥80 years of age) DLBCL patients have significantly worse overall survival, progression free survival, and treatment response rates than younger patients. However, when chemoimmunotherapy is feasible, disease relapse rates are comparable to those of younger patients, and increased mortality does not appear to be a result of increased disease relapse. Additional research is needed to establish more widely applicable, better tolerated effective treatment regimens for this patient population.
Jay Y. Spiegel, et al.
The Abstract concludes: Our analysis of 22 infused axi-cel patients showed an ORR of 86% and CR of 45%, despite 36% Zuma-1 ineligibilities and steroid use in 82%. Blood CAR-T expansion was associated with both CRS and neurotoxicity but not clinical response. Detection of high concentration of CAR-T cells in affected lymph nodes 2 days post infusion suggests quantification of CAR-T cells at disease sites could be predictive of clinical responses.