The MINI-POLATUZUMAB VEDOTINE PLUS CHP (POLA-R-CHP) VS. MINI-R-CHOP IN PATIENTS OVER 80 YEARS OF AGE WITH DIFFUSE LARGE B-CELL LYMPHOMA: A RETROSPECTIVE, PROPENSITY SCORE-MATCHED ANALYSIS STRATIFIED BY SIMPLIFIED FRAILTY SCORE PolaRCHP vs. RCHOP for older patients
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Keywords
diffuse large B cell lymphoma
Abstract
Background: Polatuzumab vedotin (Pola) combined with rituximab, cyclophosphamide, doxorubicin, and prednisolone (PRCHP) is a new standard first-line therapy; however, patients aged >80 years were excluded from the POLARIX trial. This retrospective study evaluated the efficacy and safety of mini-PRCHP and mini-rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) in older patients.
Methods: Sixty-three participants aged >80 years were treated with PRCHP, and 76 were treated with RCHOP between January 2018 and December 2024 at our hospital. Propensity score matching (PSM) was performed for Ann Arbor stage, international prognosis index, and frailty score to adjust for baseline differences.
Results: After a 1:1 PSM matching, 59 patient pairs were selected (median age: 84 years; p=0.88). Patients were classified as fit (n=9, 15%), unfit (n=21, 36%), or frail (n=29, 49%) according to their frailty scores (p=1.00). The overall response rate (ORR), complete response rate (CRR), overall survival (OS), and progression-free survival (PFS) at 12 months were not significantly different between the mini-PRCHP and mini-RCHOP groups. In patients with frailty, the 12-month PFS was not significantly different (50.9% vs. 53.7%, p=0.87); however, in non-frail patients, the PFS was significantly higher in the mini-PRCHP group than that in the mini-RCHOP group (80.8% vs. 60.1%, p=0.04). Safety profile of grade 3/4 adverse events was similar for both groups; however, peripheral neuropathy was prominent in the mini-RCHOP group (p=0.06).
Conclusion: Mini-PRCHP demonstrated efficacy and safety comparable to mini-RCHOP in older patients. Mini-PRCHP may prolong PFS in non-frail patients and reduce the risk of peripheral neuropathy.
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