Comparative effectiveness of R-minichop versus R-CHOP in older patients with diffuse large B-cell lymphoma: A propensity score-matched analysis from a real-world grupo de estudio latinoamericano de linfoproliferativos (GELL) cohort
Year: 2025
Type: conference-abstract
Abstract: INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 30–40% of non-Hodgkin lymphomas in adults. In older patients, treatment with full-dose R-CHOP is often limited by age-related frailty, comorbidities, and reduced tolerance to chemotherapy. R-miniCHOP, a reduced-intensity regimen, was developed to balance efficacy and safety in this population, but data comparing its real-world effectiveness to standard R-CHOP in Latin America (LATAM) remain limited. OBJECTIVE: To compare overall survival (OS) between elderly patients with DLBCL treated with R-miniCHOP versus standard R-CHOP using real-world data from the Grupo de Estudio Latinoamericano en Linfoproliferativos (GELL) registry. METHODS: This retrospective multicenter cohort included consecutiveness patients aged ≥65 years with newly diagnosed, histologically confirmed DLBCL treated with R-CHOP or R-miniCHOP between 2012–2017. Patients were excluded if baseline or follow-up data were incomplete. Propensity score matching (PSM) at a 3:1 ratio without caliper was performed based on age, sex, ECOG performance status, Ann Arbor stage, extranodal involvement, IPI score, and serum albumin. Missing data were imputed using a Random Forest algorithm. Post-matching balance was assessed using standardized mean differences (SMD < 0.1). OS was calculated using Kaplan–Meier curves and Cox regression. Follow-up completeness was estimated with reverse Kaplan–Meier. A subgroup analysis was conducted in patients aged >80 years. A sensitivity analysis using caliper = 0.2 was performed to confirm robustness. RESULTS: Of 482 eligible patients (421 R-CHOP; 61 R-miniCHOP), 244 remained post-matching (183 R-CHOP; 61 R-miniCHOP). Median follow-up was 30 months. Baseline covariates were well balanced after matching (all SMD < 0.1). The mean age was 76.1 years in both groups (p = 0.679), with similar distributions in sex (47.5% vs. 45.4% male), ECOG >2 (32.8% vs. 33.3%), advanced clinical stage III–IV (65.6% vs. 65.0%), elevated LDH (47.5% vs. 48.6%), extranodal involvement (27.9% vs. 29.5%), and high-risk IPI (60.7% vs. 60.1%). Serum albumin levels were also comparable between R-miniCHOP and R-CHOP groups. At 24 months, OS was 57.1% (95% CI: 48.8–66.9%) for patients treated with R-CHOP and 56.3% (95% CI: 45.0–70.5%) for those receiving R-miniCHOP. No significant difference in OS was observed (HR: 0.96; 95% CI: 0.66–1.59; p = 0.899). Among patients aged >80 years, 1-year OS was 60.0% with R-CHOP vs. 48.6% with R-miniCHOP; no statistically significant differences were found (HR: 1.35; 95% CI: 0.56–3.24; p = 0.504). Complete response was observed in 59.0% of R-miniCHOP patients and 59.0% of R-CHOP patients post-matching; partial responses occurred in 9.8% and 8.2%, respectively. Disease progression was reported in 24.6% of R-miniCHOP vs. 29.0% of R-CHOP patients. No significant differences were found across response categories (p = 0.832). Sensitivity analysis using caliper matching confirmed the robustness of results (HR: 0.98; 95% CI: 0.62–1.54; p = 0.929), with consistent survival estimates and covariate balance. CONCLUSION: In this multicenter real-world LATAM cohort, R-miniCHOP demonstrated comparable OS to standard R-CHOP in elderly patients with DLBCL, including those aged >80 years. These results support the use of R-miniCHOP as a viable frontline alternative for frail or very elderly patients in routine clinical practice, especially in resource-constrained health systems. However, prospective studies incorporating frailty assessments, quality-of-life, and toxicity outcomes are warranted to guide individualized treatment strategies in older adults with DLBCL.
Source: Blood
Authors: Rafael Pichardo-Rodriguez, Luis Mario Villela Martinez, Maria Alejandra Torres, Brady Beltran, Henry Idrobo, German Stemmelin, Sofía Rivarola, Denisse Castro, Sally Paredes, Laura Korin, Fabiola Valvert, Victoria Irigoin, Jose A Hernandez-Hernandez, Rocío Ramírez, Efreen Horacio Montaño Figueroa, Fernando Perez-Jacobo, Arianna Robles, Ana Oliver, Rosa Oliday Ríos Jiménez, Guilherme Perini, Carlos Chiattone, Jorge Castillo, Bryan Valcarcel, Luis Malpica, Myrna Candelaria
Institutions: Universidad Ricardo Palma, Universidad Autónoma de Sinaloa, Institute for Social Security and Services for State Workers, Universidad Central de Venezuela, Hospital Nacional Edgardo Rebagliati Martins, Technological University of Pereira, Hospital Británico, Hospital Británico de Buenos Aires, Instituto Alexander Fleming, Tecnológico de Monterrey, Hospital General de México, Hospital Central Norte de Petroleos Mexicanos, Pemex (Mexico), Ministerio de Salud Pública, Hospital Israelita Albert Einstein, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Dana-Farber Cancer Institute, The University of Texas MD Anderson Cancer Center, Hospital Angeles Pedregal
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4417011522