Clinical characteristics and outcomes of elderly patients with stage Ⅰ diffuse large B-cell lymphoma: a study by the Jiangsu Cooperative Lymphoma Group (JCLG)
10.3760/cma.j.cn112138-20241219-00837
- VernacularTitle:老年Ⅰ期弥漫大B细胞淋巴瘤患者的临床特征及预后分析：一项江苏省淋巴瘤协作组的多中心回顾性研究
- Author:
Yi XIA
1
;
Jing HE
;
Weiying GU
;
Tao JIA
;
Tingxun LU
;
Yongle LI
;
Jiahao ZHOU
;
Bingzong LI
;
Haiying HUA
;
Ping LIU
;
Yuqing MIAO
;
Yuexin CHENG
;
Xiaoyan XIE
;
Yunping ZHANG
;
Wenzhong WU
;
Zhuxia JIA
;
Xuzhang LU
;
Chunling WANG
;
Liang YU
;
Min XU
;
Jinning SHI
;
Weifeng CHEN
;
Wanchuan ZHUANG
;
Zhen QIAN
;
Jun QIAN
;
Haiwen NI
;
Yifei CHEN
;
Qiudan SHEN
;
Jianyong LI
;
Wenyu SHI
Author Information
1. 南京医科大学第一附属医院 江苏省人民医院血液科，南京 210029
- Publication Type:Journal Article
- Keywords:
Lymphoma, large B-cell, diffuse;
Aged;
Comorbidity;
Stage Ⅰ
- From:
Chinese Journal of Internal Medicine
2025;64(6):504-513
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis.Methods:A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model.Results:The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups ( P=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years ( HR=2.910, 95% CI 1.565-5.408, P=0.001) and/or with a CCI score ≥2 ( HR=2.324, 95% CI 1.141-4.732, P=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group ( P<0.001). Conclusions:Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.
