The Efficacy And Safety Profile Of First-line R-CDOP/CDOP Regimen In Diffuse Large B-cell Lymphoma With Cardiovascular Diseases Or High Risk Factors

Objective Toevaluate the efficacy and safety profile of first-line CDOP(cyclophosphamide,pegylated liposomal doxorubicin,vincristine,and prednisone)or R-CDOP(rituximab,cyclophosphamide,pegylated liposomal doxorubicin,vincristine,and prednisone)in diffuse large B-cell lymphoma(DLBCL)with cardiovascular diseases or risk factors.Method94 DLBCL patients who were diagnosed with at least one cardiovascular disease or risk factor and received first-line R-CDOP/CDOP chemotherapy in our institute were retrospectively reviewed.Cardiovascular diseases or risk factors were referred as:coronary heart disease,hypertension,age≥ 60,hyperlipidemia,diabetes mellitus,obesity,history of smoking,and hypothyroidism/hyperthyroidism.Result All enrolled patients had history of a cardiovascular disease or presented a high-risk group of developing cardiovascular diseases:coronary heart disease 10cases,hypertension 33cases,hyperlipidemia 44cases,diabetes mellitus 23cases,obesity 15cases,history of smoking 25cases,hypothyroidism/hyperthyroidism 3cases.74 patients had more than one cardiovascular disease or risk factors.34 patients were germinal center B-cell subtype(GCB)and 60 were non-germinal center B-cell subtype(non-GCB).First-line R-CDOP/CDOP chemotherapy was given at a median cycle of 4.5(range,2-8).Overall response rate(ORR)and complete response rate(CRR)were 92.6%(87/94)and 70.2%(66/94)for the whole group,96.5%(75/78)and 74.3%(58/78)for the R-CDOP subgroup,respectively.Grade Ⅲ/Ⅳ neutropenia and thrombocytopenia were documented in 53.2%(50/94)and 3.2%(3/94)of patients.19(20.2%)patients developed grade Ⅰ/Ⅱ cardiotoxicity.There was no grade Ⅲ/Ⅳ cardiac event causing chemotherapy delay or break off.No further cardiotoxicity occurred neither during follow-up.5-year progression-free survival(PFS)and overall survival(OS)rates were 71.3%and 76.9%for overall.For GCB subtype and non-GCB subtype,5-year PFS rates were 84.6%and 63.9%respectively(P<0.05),and 5-year OS rates were 80.6%and 74.6%respectively(P=0.407).Conclusion PLD-containing first-line R-CDOP/CDOP regimen was demonstrated as an highly effective and much tolerable alternative for DLBCL patients with cardiovascular diseases/risk factors.Diffuse large B-cell lymphoma(DLBCL)is the most common pathological subtype of non-Hodgkin’s lymphoma(NHL)with an increasing incidence,among which elderly(age≥60 years)DLBCL patients have become the leading population in this disease.Elderly DLBCL patients is characterized by specific clinical and pathological features.In addition,compared with young patients,elderly DLBCL patients are tend to have more complications,poor tolerance and inadequate compliance to treatments,resulting to inferior survival outcome with 10%-20%decrease of 5-year overall survival rate than you ng patients.Therefore,the explore of effective and tolerable treatment,as well as reliable prognosis model for elderly DLBCL patients is one of the most vital directions for study of DLBCL.And in this study,we reviewed the medical treatments of DLBCL in elderly patients.