A Fondazione Italiana Linfomi cohort study of R-COMP vs R-CHOP in older patients with diffuse large B-cell lymphoma.

R-CHOP is the most commonly used regimen worldwide for the upfront treatment of diffuse large B-cell lymphoma (DLBCL). However, it is associated with significant cardiotoxicity, especially in older patients. The R-COMP regimen, with non-pegylated liposomal doxorubicin, may reduce the risk of cardiac events, but its efficacy has never been demonstrated in prospective trials. In this report, we describe the characteristics and outcome of DLBCL patients≥65 years prospectively enrolled in the Elderly Project by the Fondazione Italiana Linfomi and treated with full doses of R-CHOP or R-COMP per local practice. Starting from a dataset of 1163 cases, 383 (55%) were treated with R-CHOP and 308 (45%) with R-COMP. Patients treated with R-COMP were older (median age 76 vs 71 years), less frequently fit at simplified geriatric assessment (61% vs 88%, p<0.001), and also had a significantly higher frequency of baseline cardiac disorders (grade >1, 32% vs 8%, p<0.001). Nevertheless, 3-year progression-free survival (PFS) was 70% for R-CHOP and 64% for R-COMP (p=ns); 3-year overall survival was 77% for R-CHOP and 71% for R-COMP (p=ns). R-CHOP was associated with better PFS vs R-COMP only in the Elderly Prognostic Index (EPI) low-risk group. No differences between the two groups were observed in terms of interruption of treatment due to toxicities or in the rate of cardiac events (p=1.00). Our study suggests that R-COMP represents a potentially curative treatment for EPI intermediate-/high-risk older patients, even in the presence of a baseline cardiopathy. R-CHOP is confirmed as the standard therapy for patients at low risk.