O2-12-3Safety and efficacy of R-THP-COP for over 80 years elderly patients with diffuse large B-cell lymphoma

Background: We previously noted high incidence of diffuse large B-cell lymphoma (DLBCL) in elderly patients (pts). Therefore, we evaluated the efficacy and safety of R-THP-COP regimen in over 80 years elderly pts with DLBCL newly diagnosed in our hospital from January 2009 to December 2014. Results: A total of 22 pts (median 82 years old, range 80-89) were evaluated. Twelve of 22 pts (55%) had stage III-IV. IPI classified low or low-int in 6 pts (28%) and high-int or high in 16 pts (72%). Fourteen of 22 pts (64%) had poor performance status (PS 2-4) at initial treatment. All pts received THP-COP therapy with (n = 19) or without (n = 3) Rituximab. Their THP-COP therapy comprised from pirarubicin (median 30mg/m2, range 19-39), cyclophosphamide (median 455 mg/m2, range 296-526), vincristine (median 0.8mg/m2, range 0-1.0) on day1, and prednisolone (median 80mg/body, range 30-100) during day1 to 5. Only 7 pts completed 6 cycles of the therapy. The incidences of grade 4 neutropenia was 73% (n = 16). Infectious complication was recognized in 12 pts, which included febrile neutropenia (n = 6), pneumonia (n = 3), bacteremia (n = 2), enterocolitis (n = 1). Other toxicities were steroid diabetes (n = 1), dementia (n = 1), AMI (n = 1), HBV reactivation (n = 1). Therapy related death was observed at only 1 patient (5%) due to AMI. Overall and complete response rate were 77% and 50%, respectively. Especially all pts whose IPI was low or low-int had 100% of response rate. Median duration of hospitalization was 64 days (range 10-140 days). Conclusion: We conclude that the dose-reduction THP-COP is an effective regimen for elderly pts over 80 years old, especially in pts with favorable prognostic factors. However, it is required to improve the infectious complication and prolonged hospitalization.