Serum Albumin Levels Strongly Predict Survival Outcome of Elderly Patients with Diffuse Large B-Cell Lymphoma Treated with Rituximab-Combined Chemotherapy

Hiroto Kaneko; Kazuho Shimura; Mihoko Yoshida; Yosuke Matsumoto; Tsutomu Kobayashi; Hitoji Uchiyama; Junya Kuroda; Masafumi Taniwaki

doi:10.18502/ijhoscr.v16i1.8433

Hiroto Kaneko Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana-Shichouno-cho, Yamashina-ku Kyoto 607-8086, Japan
Kazuho Shimura Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana-Shichouno-cho, Yamashina-ku Kyoto 607-8086, Japan
Mihoko Yoshida Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana-Shichouno-cho, Yamashina-ku Kyoto 607-8086, Japan
Yosuke Matsumoto Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto 605-8601, Japan
Tsutomu Kobayashi Department of Hematology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
Hitoji Uchiyama Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto 605-8601, Japan
Junya Kuroda Department of Hematology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
Masafumi Taniwaki Department of Hematology, Aiseikai Yamashina Hospital, 19-4 Takehana-Shichouno-cho, Yamashina-ku Kyoto 607-8086, Japan

DOI: https://doi.org/10.18502/ijhoscr.v16i1.8433

Keywords: Diffuse large B-cell lymphoma; Elderly; Rituximab combined cyclophosphamide; Doxorubicin; Vincristine and prednisolone (R-CHOP); Albumin

Abstract

Background: In the current Japanese aging society, a high number of very elderly patients (age ranged from 80 to 93) with diffuse large B-cell lymphoma (DLBCL, most frequent hematological malignancy), who require chemotherapy are encountered. However, standard chemotherapy can result in severe adverse effects in elderly patients. Although various scoring systems are available to assess frailty, they are too complicated to immediately make a therapeutic decision, and studies on indications for chemotherapy in elderly patients are few.

Materials and Methods: In the present study, we retrospectively analyzed the clinical records of 56 patients with DLBCL aged 80 or older who received R-CHOP or similar chemotherapy. Association of various clinical parameters, including performance status, stage, B symptom(s), laboratory data and relative dose intensity and survival outcomes was examined.

Results: Pretreatment serum albumin level was identified as the only factor that predicts overall and progression-free survivals.

Conclusion: We have concluded that very elderly DLBCL patients aged 80 or older with hypoalbuminemia may be unfit for standard chemotherapy, regardless of other factors. Alternative or palliative therapy should be considered for those patients.