***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Very elderly patients ( 75 years and older ) with diffuse large B-cell lymphoma ( DLBCL ) will be increasingly considered for cancer treatment as the population ages , but are underrepresented in clinical trials . Here we report outcomes of very elderly DLBCL patients treated in the modern era at the Oregon Health and Science University ( OHSU ) . Methods : We queried the OHSU Tumor Registry for DLBCL cases treated since 2002 . A total of 73 patients aged 75 years or older were analyzed under Institutional Review Board approval . Results : With a median follow up of 31 months , cause-specific survival was 58 % and overall survival 51 % at 3 years . Incorporation of an anthracycline did not influence outcomes . More than one extranodal site or poor-risk disease by Revised International Prognostic Index score were adversely prognostic , but pathologic features studied were not . Conclusions : Very elderly patients with DLBCL require prospect i ve studies , which employ novel risk stratification and therapeutic approaches BACKGROUND Cyclophosphamide , doxorubicin , vincristine , and prednisolone ( CHOP ) is used to treat patients with non-Hodgkin lymphoma . Interval decrease from 3 weeks of treatment ( CHOP-21 ) to 2 weeks ( CHOP-14 ) , and addition of rituximab to CHOP-21 ( R-CHOP-21 ) has been shown to improve outcome in elderly patients with diffuse large B-cell lymphoma ( DLBCL ) . This r and omised trial assessed whether six or eight cycles of R-CHOP-14 can improve outcome of these patients compared with six or eight cycles of CHOP-14 . METHODS 1222 elderly patients ( aged 61 - 80 years ) were r and omly assigned to six or eight cycles of CHOP-14 with or without rituximab . Radiotherapy was planned to sites of initial bulky disease with or without extranodal involvement . The primary endpoint was event-free survival ; secondary endpoints were response , progression during treatment , progression-free survival , overall survival , and frequency of toxic effects . Analyses were done by intention to treat . The trial is registered on National Cancer Institute website , number NCT00052936 and as EU-20243 . FINDINGS 3-year event-free survival was 47.2 % after six cycles of CHOP-14 ( 95 % CI 41.2 - 53.3 ) , 53.0 % ( 47.0 - 59.1 ) after eight cycles of CHOP-14 , 66.5 % ( 60.9 - 72.0 ) after six cycles of R-CHOP-14 , and 63.1 % ( 57.4 - 68.8 ) after eight cycles of R-CHOP-14 . Compared with six cycles of CHOP-14 , the improvement in 3-year event-free survival was 5.8 % ( -2.8 - 14.4 ) for eight cycles of CHOP-14 , 19.3 % ( 11.1 - 27.5 ) for six cycles of R-CHOP-14 , and 15.9 % ( 7.6 - 24.2 ) for eight cycles of R-CHOP-14 . 3-year overall survival was 67.7 % ( 62.0 - 73.5 ) for six cycles of CHOP-14 , 66.0 % ( 60.1 - 71.9 ) for eight cycles of CHOP-14 , 78.1 % ( 73.2 - 83.0 ) for six cycles of R-CHOP-14 , and 72.5 % ( 67.1 - 77.9 ) for eight cycles of R-CHOP-14 . Compared with treatment with six cycles of CHOP-14 , overall survival improved by -1.7 % ( -10.0 - 6.6 ) after eight cycles of CHOP-14 , 10.4 % ( 2.8 - 18.0 ) after six cycles of R-CHOP-14 , and 4.8 % ( -3.1 - 12.7 ) after eight cycles of R-CHOP-14 . In a multivariate analysis that used six cycles of CHOP-14 without rituximab as the reference , and adjusting for known prognostic factors , all three intensified regimens improved 3-year event-free survival ( eight cycles of CHOP-14 : RR [ relative risk ] 0.76 [ 0.60 - 0.95 ] , p=0.0172 ; six cycles of R-CHOP-14 : RR 0.51 [ 0.40 - 0.65 ] , p<0.0001 ; eight cycles of R-CHOP-14 : RR 0.54 [ 0.43 - 0.69 ] , p<0.0001 ) . Progression-free survival improved after six cycles of R-CHOP-14 ( RR 0.50 [ 0.38 - 0.67 ] , p<0.0001 ) , and eight cycles of R-CHOP-14 ( RR 0.59 [ 0.45 - 0.77 ] , p=0.0001 ) . Overall survival improved only after six cycles of R-CHOP-14 ( RR 0.63 [ 0.46 - 0.85 ] , p=0.0031 ) . In patients with a partial response after four cycles of chemotherapy , eight cycles were not better than six cycles . INTERPRETATION Six cycles of R-CHOP-14 significantly improved event-free , progression-free , and overall survival over six cycles of CHOP-14 treatment . Response-adapted addition of chemotherapy beyond six cycles , though widely practice d , is not justified . Of the four regimens assessed in this study , six cycles of R-CHOP-14 is the preferred treatment for elderly patients , with which other approaches should be compared Cyclophosphamide , doxorubicin , vincristine , and prednisone , given every 3 weeks ( CHOP-21 ) , is st and ard chemotherapy for aggressive lymphomas . To determine whether biweekly CHOP ( CHOP-14 ) with or without etoposide is more effective than CHOP-21 , 689 patients ages 61 to 75 years were r and omized to 6 cycles of CHOP-21 , CHOP-14 , CHOEP-21 ( CHOP plus etoposide 100 mg/m2 days 1 - 3 ) , or CHOEP-14 . Patients in the 2-weekly regimens received granulocyte colony-stimulating factor ( G-CSF ) starting from day 4 . Patients received radiotherapy ( 36 Gy ) to sites of initial bulky disease and extranodal disease . Complete remission rates were 60.1 % ( CHOP-21 ) , 70.0 % ( CHOEP-21 ) , 76.1 % ( CHOP-14 ) , and 71.6 % ( CHOEP-14 ) . Five-year event-free and overall survival rates were 32.5 % and 40.6 % , respectively , for CHOP-21 and 43.8 % and 53.3 % , respectively , for CHOP-14 . In a multivariate analysis , the relative risk reduction was 0.66 ( P = .003 ) for event-free and 0.58 ( P < .001 ) for overall survival after CHOP-14 compared with CHOP-21 . Toxicity of CHOP-14 and CHOP-21 was similar , but CHOEP-21 and in particular CHOEP-14 were more toxic . Due to its favorable efficacy and toxicity profile , CHOP-14 should be considered the new st and ard chemotherapy regimen for patients ages 60 or older with aggressive lymphoma Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies , posing the dilemma of whether to intensify therapy , thereby improving the cure rate , or de-escalate therapy , thereby reducing toxicity , with consequent risks for under- or overtreatment . Adequate tools to define doses and combinations have not been identified for lymphoma patients . We conducted a prospect i ve trial aim ed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment ( CGA ) in elderly ( aged ≥70 years ) patients with diffuse large B-cell lymphoma ( DLBCL ) . In June 2000 to March 2006 , 100 patients were stratified using a CGA into three groups ( fit , unfit , and frail ) , and they received a rituximab plus cyclophosphamide , doxorubicin , vincristine , and prednisone modulated in dose and drugs according to comorbidities and activities of daily living ( ADL ) and instrumental ADL scores . Treatment was associated with a complete response rate of 81 % and mild toxicity : grade 4 neutropenia in 14 % , anemia in 1 % , and neurological and cardiac toxicity in 2 % of patients . At a median follow-up of 64 months , 51 patients were alive , with 5-year disease-free , overall , and cause-specific survival rates of 80 % , 60 % , and 74 % , respectively . Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL . Wide use of this CGA-driven treatment may result in better cure rates , especially in fit and unfit patients Enormous progress has been made in the treatment of diffuse large B-cell lymphoma ( DLBCL ) , mostly due to the anti-CD20 antibody rituximab . More than 50 % of elderly DLBCL patients can be expected to be cured by modern immunochemotherapy . The st and ard chemotherapy partner of rituximab is the CHOP ( cyclophosphamide , doxorubicin , vincristine , and prednisone ) regimen .  Elderly patients need particular attention and thorough evaluation if they are suited for the st and ard treatment or if they are c and i date s for palliative treatment . Rigorous supportive care including anti-infectious prophylaxis and growth factor support are m and atory . Whether there is still a role of additive radiotherapy in the R-CHOP era is under debate . While further intensification of chemotherapy might hardly be feasible in elderly patients , dose and schedule of rituximab appear to be optimizable . Patients failing after R-CHOP are a particular challenge as are frail patients who are not fit enough for R-CHOP . Further progress can be expected from novel antibodies and small molecules that interfere with signal transduction pathways essential for the survival of the lymphoma cell . To achieve this goal , prospect i ve trials with large numbers of patients are necessary for which the continuous commitment of patients and physicians is indispensable We investigated the predictive value of geriatric assessment ( GA ) on overall survival ( OS ) for older adults with acute myelogenous leukemia ( AML ) . Consecutive patients ≥ 60 years with newly diagnosed AML and planned intensive chemotherapy were enrolled at a single institution . Pretreatment GA included evaluation of cognition , depression , distress , physical function ( PF ) ( self-reported and objective ly measured ) , and comorbidity . Objective PF was assessed using the Short Physical Performance Battery ( SPPB , timed 4-m walk , chair st and s , st and ing balance ) and grip strength . Cox proportional hazards models were fit for each GA measure as a predictor of OS . Among 74 patients , the mean age was 70 years , and 78.4 % had an Eastern Cooperative Oncology Group ( ECOG ) score ≤ 1 . OS was significantly shorter for participants who screened positive for impairment in cognition and objective ly measured PF . Adjusting for age , gender , ECOG score , cytogenetic risk group , myelodysplastic syndrome , and hemoglobin , impaired cognition ( Modified Mini-Mental State Exam < 77 ) and impaired objective PF ( SPPB < 9 ) were associated with worse OS . GA methods , with a focus on cognitive and PF , improve risk stratification and may inform interventions to improve outcomes for older AML patients Background . Although chemotherapy added to rituximab is a st and ard of care for diffuse large B cell lymphoma ( DLBCL ) , treatment of patients ≥65 years of age remains controversial due to comorbidities . Methods . This is a retrospective , comparative , nonr and omized study of patients ≥65 years of age , who were diagnosed with DLBCL but not previously treated . Demographic characteristics and comorbidities were analyzed . Three rituximab-containing treatment regimens ( st and ard RCHOP , anthracycline dose-reduced RChOP , and RCOP ) were compared . Descriptive analyses were conducted . Survival was calculated with the Kaplan-Meier method , and differences were compared with the log-rank test . Results . In total , 141 patients with a median age of 73.9 years were studied . The three treatment groups had comparable demographic characteristics . The overall response was 77 % , 72.5 % , and 59 % in groups treated with RCHOP , RChOP , and RCOP , respectively . After multivariate analysis , the factors influencing the overall survival were the presence of B symptoms , poor performance status ( ECOG ≥ 3 ) , and febrile neutropenia . Factors influencing disease-free survival were febrile neutropenia , high-intermediate and high-risk IPI scores , and treatment without anthracycline 
    Output:
    
With limited prospect i ve data , we find that pretreatment comprehensive geriatric assessment accurately predicts survival and treatment-related toxicities , suggesting its potential role in guiding overall treatment decision-making