Comparative Effectiveness of R-miniCOMP Versus R-miniCHOP in Older Non-Fit Patients With Diffuse Large B-Cell Lymphoma: Insights From a "Fondazione Italiana Linfomi" Cohort Study.

The R-miniCHOP regimen is the standard first-line treatment for diffuse large B-cell lymphoma (DLBCL) in older unfit or frail patients. Recent research suggests that replacing doxorubicin with non-PEGylated liposomal doxorubicin (NPLD) is safe and effective for DLBCL. However, the outcomes of DLBCL patients receiving NPLD as part of a reduced-intensity regimen approach have yet to be investigated. This study aimed to assess non-fit DLBCL patients enrolled in the Elderly Project (EP) conducted by the Fondazione Italiana Linfomi (FIL) who were treated with R-miniCHOP or R-miniCOMP. The primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS), respectively. Of the 1163 cases within the EP cohort, we identified 176 patients (18%) who resulted unfit or frail at simplified geriatric assessment (sGA) and received either R-miniCHOP (89 cases; 51%) or R-miniCOMP (87 cases; 49%). Both cohorts exhibited similar clinical characteristics, a similar distribution of unfit and frail cases using the sGA and similar Elderly Prognostic Index (EPI) scores. After a median follow-up of 28 months, the 3-year OS and PFS rates were 61% and 54% respectively, with no significant difference between R-miniCHOP and R-miniCOMP. Notably, the therapeutic regimen had no significant impact on OS (HR 1.07, 95% CI: 0.63-1.82, p = 0.798) or PFS (HR 1.00, 95% CI: 0.62-1.6, p = 0.999) even after adjusting for propensity score (PS) and inverse probability weighting (IPW). A comprehensive survival analysis within vulnerable geriatric categories (unfit and frail patients) confirmed non-significant variations in predictive efficacy between R-miniCHOP and R-miniCOMP. Of note the independent prognostic role of EPI is confirmed for both OS and PFS. This study suggests that R-miniCHOP is still the preferred treatment for unfit and frail older DLBCL. The role of R-miniCOMP for specific subgroups of older DLBCLs warrants confirmation in larger studies.