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anthracycline-containing regimens, the 3-year OS is Results
almost halved when a non-anthracycline-containing
regimen is used with an absolute survival reduction of Patients’ characteristics
23%. [12] CHOP and CVP were administered to 351 (84%) and
67 (16%) patients, respectively. Compared with those
Thus, the aim of this retrospective study was to
investigate the effectiveness of non-anthracycline receiving CVP, patients receiving CHOP were signifi cantly
chemotherapy regimen on elderly DLBCNHL patients younger, having less comorbidity, better performance
by mainly focusing on geriatric organ dysfunction, frailty status (PS), fewer B-symptoms, and lower International
and comorbidities vs. suboptimal treatment with the Prognostic Index-risk (IPI-risk) categories [Table 1].
cyclophosphamide, vincristine, and prednisone (CVP) vs. Logistic regression analysis assessed the impact of different
the standard CHOP to assess the factors that impact the baseline characteristics on the likelihood to receive CHOP
regimen choice. or CVP. Only age and comorbidities were independent
determinants of the regimen received [Table 2]. Older
Methods patients had 10.5 odds of not receiving CHOP compared
to the younger patients (95% confi dence interval (CI):
Study population 4.6-23.6; P < 0.001). Patients with comorbidities had 37.2
This retrospective clinical study included 418 patients odds of not receiving CHOP compared to those with no
with a confi rmed DLBCNHL diagnosis at Tanta Cancer comorbidities (95% CI: 12.6-109.6; P < 0.001).
Center, Gharbiah, Egypt between 2003 and 2006.
Diagnosis of DLBCNHL was based on histology and Table 1: Characteristics of 418 DLBCNHL patients
immunohistochemical data on CD19, CD20, and CD Characteristic Subgroup n (%) P
22 expression. Patients were treated with either CHOP CHOP CVP
chemotherapy regimen (c yclophosphamide 750 mg/m n 351 67
2
2
intravenous (IV) on day 1, doxorubicin 50 mg/m IV Age Mean ± SD 48.6 ± 13.3 69.7 ± 8.8 < 0.001
on day 1, vincristine 1.4 mg/m (maximum 2 mg) IV < 70 334 (95.2) 29 (43.3)
2
on day 1 and prednisone 100 mg p.o. for 5 days) or ≥ 70 17 (4.8) 38 (56.7) < 0.001
CVP regimen (same as CHOP without doxorubicin) and LDH ≤ Normal 78 (22.2) 12 (17.9)
followed-up until March 2014 via phone conversation. > Normal 273 (77.8) 55 (82.1) 0.431
Response to therapy was assessed using the response Gender Female 176 (50.1) 30 (44.8)
criteria developed by the lymphoma International Male 175 (49.9) 37 (55.2) 0.421
Working Group. OS is calculated from the date of Comorbidity No 289 (82.3) 4 (6.0)
[14]
diagnosis to the date of death from any cause or last Yes 62 (17.7) 63 (94) < 0.001
follow-up. Event-free survival (EFS) was calculated Bulky disease Yes 40 (11.4) 6 (9.0)
from the date of starting treatment to the date of No 311 (88.6) 61 (91.0) 0.673
[14]
relapse, progression, death or last follows up. PS grouping 0-1 221 (63.0) 21 (31.3)
Clinicopathological data were extracted from patients’ 2-4 130 (37.0) 46 (69.7) < 0.001
medical records. This study was approved by the Extra-nodal No 232 (66.1) 44 (65.7)
Institutional Review Board of the Egyptian National disease Yes 119 (33.9) 23 (34.3) 0.946
Cancer Institute. Stage 1 68 (19.4) 16 (23.9)
2 128 (36.5) 20 (29.9)
Statistical analyses 3 119 (33.9) 23 (34.3)
Statistical analyses were performed using IBM SPSS 4 36 (10.3) 8 (11.9) 0.701
software version 21.0 (SPSS Inc., Chicago, IL, USA). B symptoms A 191 (54.4) 27 (40.3)
Nominal and categorical variables were compared B 160 (45.6) 40 (59.7) 0.034
using the Chi-square or Fisher’s exact test. Numerical IPI risk category Low 85 (24.2) 3 (4.5)
variables were compared using t-test or Man-Whitney’s Low 150 (42.7) 15 (22.4)
test. Multivariate logistic regression was used to describe intermediate
the use of CHOP or CVP, controlling for patient High 86 (24.5) 18 (26.9)
covariates. Unadjusted survival was estimated using intermediate
the Kaplan-Meier method and groups were compared High 30 (8.5) 31 (46.3) < 0.001
using the log-rank test. Stepwise Cox regression hazards aaIPI groups 0-1 90 (25.6) 17 (25.4)
model was used for calculating adjusted survival for 2-3 261 (74.4) 50 (74.6) 0.963
each treatment, controlling for patients covariates. DLBCNHL: Diffuse large B-cell non-Hodgkin’s lymphoma;
CHOP: Cyclophosphamide, doxorubicin, vincristine, and
A probability P ≤ 0.05 was considered statistically prednisone; CVP: Cyclophosphamide, vincristine, and prednisone;
signifi cant. The primary endpoint was OS. The secondary SD: Standard deviation; LDH: Lactate dehydrogenase;
endpoint included EFS, complete response (CR) rate, and IPI: International prognostic index; aaIPI: Age-adjusted
treatment-related toxicities. international prognostic index; PS: Performance status

Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 2 ¦ July 15, 2015 ¦ 77