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Background: Older patients with DLCL are underrepresented in clinical trials, and little is known about the impact of age on therapeutic decisions outside the clinical trial setting. Treatment for older individuals can be influenced by comorbidities, possibly limiting the use of proven aggressive therapies. We investigated the effects of age on patterns of presentation and treatment for patients with DLCL. Methods: Data from the 5 centers participating in the NCCN NHL Outcomes Project were used for analysis. Patients with newly diagnosed DLCL, receiving some or all of their care at the NCCN institutions, with first presention between 7/01/2000 to 6/30/2004 were included. Independent variables evaluated were stage, International Prognostic Index (IPI), Charlson comorbidity score, NCCN center, and age (≤ 60 and >60). Components of IPI were evaluated as separate independent variables. Fisher’s exact tests compared baseline characteristics between age groups. Univariate and multivariate logistic regression models were developed to identify factors associated with the receipt of anthracycline-based first-line therapy. Results: Of 417 patients presenting with newly diagnosed DLCL, 376 were eligible for analysis. Older patients (>60 years) accounted for 38% (142/376) of our cohort. The median age was 55.6 years; among older patients, over half were over 70. Older patients were significantly more likely to have HI/H IPI scores (52% vs. 27%, p=0.0001) and more than 2 major comorbidities (29% vs. 8%, p=0.0001). Overall, 18% (66/376) participated in first-line clinical trials, with no difference in participation by age (p=0.49). Among the 310 patients treated off protocol, 93% (289) received an anthracycline-containing first-line regimen. Older patients were less likely to receive anthracyclines [87% (105/120) vs. 97% (184/190)]. Among patients receiving anthracyclines, older patients were more likely to receive growth factor support [78% (82/105) vs.54% (100/184)]. In multivariable logistic regression adjusting for stage, comorbidity, and center, age was the only factor statistically significantly associated with treatment choice, with patients over 60 less likely to receive an anthracycline-based first-line regimen (OR=0.29; 95% CI=0.11 to 0.80 p=0.02). Conclusions: In a large cohort of patients with newly diagnosed DLCL, we found that older patients (>60 years) with DLCL had both higher risk disease, and more comorbidity at diagnosis. In our centers, there was no difference in clinical trail participation between older and younger patients; however, older patients were less likely to receive anthracyclines.

Background: Older patients with DLCL are underrepresented in clinical trials, and little is known about the impact of age on therapeutic decisions outside the clinical trial setting. Treatment for older individuals can be influenced by comorbidities, possibly limiting the use of proven aggressive therapies. We investigated the effects of age on patterns of presentation and treatment for patients with DLCL.

Granulocyte Colony-Stimulating Factor (GCSF) at 10 microg/kg (with or without chemotherapy) is the standard dose commonly administered to patients undergoing Peripheral Blood Stem Cell (PBSC) mobilization and collection. Due to various host and disease factors, 10–20% of our patients failed to mobilize sufficient PBSC at this standard dose. At our institution it is common practice to increase GCSF from 10 microg/kg to 16–20 microg/kg during the initial or second mobilization attempt if the patient is able to tolerate the increased dose.

Granulocyte Colony-Stimulating Factor (GCSF) at 10 microg/kg (with or without chemotherapy) is the standard dose commonly administered to patients undergoing Peripheral Blood Stem Cell (PBSC) mobilization and collection. Due to various host and disease factors, 10–20% of our patients failed to mobilize sufficient PBSC at this standard dose. At our institution it is common practice to increase GCSF from 10 microg/kg to 16–20 microg/kg during the initial or second mobilization attempt if the patient is able to tolerate the increased dose. To assess the clinical efficacy of increased GCSF administration among patients who fail to mobilize at the standard dose, we performed a retrospective chart review of 112 patients who underwent stem cell mobilization and collection between 01/31/2000 and 11/6/2003. The median age at the start of collection was 51.2 (range: 1.3–72.2); the case-series was made up of 52 men and 60 women. The majority of the cases were Lymphoma patients (Non-Hodgkin’s Lymphoma=52; Hodgkins Disease=15) with the remaining patients classified as Acute Myeloid Leukemia (AML=12), Multiple Myeloma (MM=13), or ‘Other’ (N=20). Initially all 112 patients received 4–10 days of GCSF at 10 microg/kg per day before the first day of PBSC collection. Because these patients failed to collect sufficient daily CD34 cells, the GCSF dose was increased to 16–20 microg/kg. Before increasing the GCSF dose, the median CD34 daily yield was 0.19 (range: 0.03–0.90), and the median peripheral WBC was 27.6 (range: 1.3–61.8). The median number of collection at 10 microg/kg was 4 (range 2–15), and the median number of days from the end of collection at 10 microg/kg to the start of 16–20 microg/kg was 1 (range: 0–53). After increasing the GCSF dose the median peripheral WBC was 37.1 (range: 3.1–70.2), and the median CD34 daily yield was 0.28 (range: 0.03–3.43). The median CD34 total yield was 3.1 (range 0.6–12.3). Ultimately 90 patients (80%) reached a CD34 cell target of 2*10–6/kg (range: 2.0–12.3), and 22 patients (20%) did not reach this target. The overall difference in CD34 counts pre-post increased GCSF administration was statistically significant (Wilcoxon p<0.01). The difference in CD34 counts (pre-post increase GCSF dose) was explained by age only; the patient’s diagnosis and gender had no statistically significant explanatory value. Patients less than 40 years of age were more likely to have successful PBSC collection with an increase dose of GCSF (p=0.02). The mean difference in daily CD34 yield for patients <40 years was 0.38; for patients ≥40 years was 0.11. Based on this analysis we recommend to increase GCSF dose to 16microg to 20 microgram/kg among the younger (<40 years) patients who failed a standard dose regimen at 10microg/kg, while other re-mobilization regimens should be considered for older patients irrespective of their gender or underlying diagnosis.