Granulocyte-colony stimulating factor (G-CSF) may improve disease outcome in elderly patients with diffuse large cell lymphoma (DLCL) treated with CHOP chemotherapy

Advanced age is an adverse prognostic factor in patients with DLCL. CHOP (c yclophosphamide, doxorubicin, vincristine, and prednisone) has frequent dos e-limiting toxicities, including myelosuppression. We retrospectively revie wed 50 consecutive patients >60 years of age (median age 72) with B-cell DL CL who received CHOP with G-CSF. Patients received CHOP (median 6 cycles) a t three-week intervals. G-CSF was given following all cycles of chemotherap y ("prophylactic G-CSF") in 28 of 50 patients, and following an episode of febrile neutropenia and thereafter in 19 patients, according to ASCO guidel ines. Dose intensity, treatment delays, episodes of febrile neutropenia, co mplete response (CR) rate, disease-free survival, time-to-treatment failure , and overall survival were all analyzed according to the age-adjusted Inte rnational Prognostic Index (aaIPI). The actual dose intensity for cyclophos phamide was 225.9 mg/m(2)/week and 0.90, respectively and for doxorubicin w as 14.9 mg/m(2)/week (90% of ideal CHOP dosing for both drugs).. Median fol lowup was 4 years for the patients still living. Treatment delays and episo des of febrile neutropenia were less frequent among patients receiving G-CS F with all cycles of CHOP. The CR rates were 100%, 81%, 85%, and 36% for th e low, low-intermediate, high-intermediate, and high aaIPI risk groups, res pectively. The 5-year actuarial relapse-free and overall survival for our p atients were comparable to that of the cohort less than or equal to 60 year s of age and superior to the >60 years of age cohort used to establish the aaIPI. With optimization of CHOP dosing, advanced age may not be an adverse prognostic factor for patients with DLCL. The routine use of G-CSF in elde rly patients with DLCL should be further investigated.