A new study evaluated risk factors for infection-related outcomes in patients 70 years of age and older with diffuse large B-cell lymphoma (DLBCL) receiving rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), and an association was found with dose intensity. The study was reported in the journal Blood Advances.

The study investigators analyzed patient, disease, and treatment characteristics to determine risk factors for infection-related morbidity and mortality in patients with DLBCL who were at least 70 years of age. Evaluated patients were receiving a full or attenuated dose of R-CHOP. Intended dose intensity (IDI) was categorized as ≥80% for a full dose and <80% for an attenuated dose.

A total of 690 patients were evaluated in this study for a median follow-up of 2.8 years. Patients had a median age of 77 years, and slightly more than one-third (34.4%) were at least 80 years of age.

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The rate of infection-related hospitalization was higher among patients receiving treatment with an IDI of ≥80%, with a 33% hospitalization rate, compared to a 23.3% hospitalization rate among those receiving an IDI of <80%. This reflected an increased odds of 1.61 (95% CI, 1.15-2.25; P =.006).

Infection-related death occurred with cumulative incidences ranging from 3.3% at 6 months to 11.1% at 5 years after diagnosis. At both 2 years and 5 years, independent risk factors for death related to infection were an International Prognostic Index score of 3 to 5, a score of 6 or higher on the Cumulative Illness Rating Scale-Geriatric, and a serum albumin level of less than 36 g/L.

“We demonstrate that across all patients age 70 years or older, those receiving an IDI ≥80% were at an independently higher risk of an infection-related admission during treatment with R-CHOP, although they were not at higher risk of dying as a result of infection,” the study investigators wrote in their report.


Eyre TA, Wilson W, Kirkwood AA, et al. Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP. Blood Adv. 2021;5(8):2229-2236. doi:10.1182/bloodadvances.2021004286