The use of upfront, metronomic chemotherapy can potentially achieve remission in elderly and frail patients with diffuse large B-cell lymphoma (DLBCL), according to a study published in the Journal of Clinical Medicine.

Standard intravenous chemotherapy, which is traditional used with success in younger and more fit DLBCL patients, has had less success in elderly and frail patients and has yet to become the standard of care. The study found that an all-oral metronomic combination of chemotherapies achieved a complete remission in 64% of patients by the end of the induction period.

The chemotherapy combination of deltacortene/prednisolone (PDN), etoposide (ETO), vinorelbine (VNR), and cyclophosphamide, with the addition of rituximab (R-DEVEC), was able to achieve overall survival (OS) and event-free survival (EFS) rates of 54% for both at 24 months. The time to progression was 74% at 24 months.

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“The main clinical result consists in the ability of upfront R-DEVEC, to achieve long-lasting remission in Elderly/Frail DLBCL. Moreover, based on this extended clinical experience, we were able to provide more accurate, practical suggestions about dosing, duration, and administration of R-DEVEC, in very elderly and frail subjects,” the authors said.

The study also investigated the individual effects of metronomic VNR and ETO on the DLBCL cell line OCI-LY3 with both significantly inhibiting cell proliferation and promoting apoptosis. The combination of the 2 drugs was also synergistic suggesting that their combination was far more effective than just the single treatment using either.

A total of 22 patients were enrolled in the study and received R-DEVEC. All subjects were elderly and 18 (82%) were 80 years of age or older. All but 1 patient, who was unfit, were categorized as Fairl or Super-frail using the comprehensive geriatric assessment (CGA). Six induction cycles were completed in 15 of the patients.

After a median follow-up of 24 months (range, 4-80 months), 15 of the patients had died. Of the deaths, 7 were for causes unrelated to DLBCL or treatment, 6 were from disease progression, and 2 from multiorgan failure, however, these 2 patients had stopped treatment following cycles 1 and 2 because of excess toxicity. None of the deaths were considered as directly caused by treatment toxicity by the authors.


Bocci G, Pelliccia S, Orlandi P, et al. Remarkable remission rate and long-term efficacy of upfront metronomic chemotherapy in elderly and frail patients, with diffuse large B-cell lymphoma. J Clin Med. Published online December 1, 2022. doi:10.3390/jcm11237162