***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: The purpose of this phase 2 , multicenter study was to determine the activity and safety of nonpegylated liposomal doxorubicin as part of " R-COMP " combination in patients with diffuse large B-cell lymphoma and coexisting cardiac disorders . The study was conducted using a Bayesian continuing assessment method using complete remission rate and rate of cardiac events as study endpoints . Between November 2009 and October 2011 , 50 evaluable patients were enrolled ( median age , 76 years ) . Median baseline left ventricular ejection fraction ( LVEF ) was 60 % . Ischemic cardiopathy was the most frequent preexisting cardiac disorder ( 35 % ) , followed by atrial fibrillation ( 15 % ) , left ventricular hypertrophy ( 13 % ) , and baseline LVEF < 50 % ( 12 % ) . Based on the intent to treat analysis , overall response rate was 72 % , including 28 patients in complete remission ( complete remission rate , 56 % ) , and 8 in partial remission ( 16 % ) . At the end of treatment , grade s 3 to 4 cardiac events were observed in 6 patients . No significant modifications from baseline values of LVEF were observed during treatment and follow-up . Nonpegylated liposomal doxorubicin instead of doxorubicin in the R-CHOP ( rituximab , cyclophosphamide , doxorubicin , vincristine , and prednisone ) regimen is a feasible option for patients with diffuse large B-cell lymphoma presenting with concomitant cardiac disorders 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 BACKGROUND The combination of rituximab , gemcitabine , and oxaliplatin ( R-GemOx ) has shown high efficacy with a low toxicity profile in elderly patients with relapsed and refractory diffuse large B-cell lymphoma . We aim ed to evaluate the efficacy , safety , and feasibility of the R-GemOx regimen as a first-line treatment in elderly patients with diffuse large B-cell lymphoma . METHODS In this single-arm , open-label , phase 2 clinical trial , we enrolled patients with previously untreated , histologically confirmed , CD20-positive diffuse large B-cell lymphoma , aged 70 years or older , or aged 60 - 69 years with an Eastern Cooperative Oncology Group ( ECOG ) performance status score of 2 or greater . Patients were recruited from Jiangsu Province Hospital ( Jiangsu Sheng , China ) .  The R-GemOx regimen was administered intravenously : rituximab 375 mg/m2 on day 0 ; gemcitabine 1 g/m2 on day 1 ; and oxaliplatin 100 mg/m2 on day 1 . The cycle was repeated every 14 days . Six cycles were planned if the patient achieved at least partial remission after the interim assessment . The primary endpoint was the proportion of patients who achieved an overall response at the end of treatment ( defined as complete response plus partial response ) . Analyses were done by intention to treat . The trial is ongoing but no longer recruiting patients . This study is registered with Clinical Trials.gov , number NCT01670370 . FINDINGS Between Aug 22 , 2012 , and Dec 31 , 2015 , 60 patients were enrolled and included in the study . The median age of the patients was 75 years ( IQR 70 - 80 ) and 27 ( 45 % ) patients had a poor performance status with an ECOG score of 2 or greater . 45 ( 75 % ) patients achieved an overall response at the end of the treatment , with 28 ( 47 % ) achieving a complete response . Common grade 3 - 4 adverse events were haematological toxicities ( thrombocytopenia in five [ 8 % ] patients , anaemia in four [ 7 % ] , and neutropenia in nine [ 15 % ] ) and gastrointestinal complications ( nausea in five [ 8 % ] patients , vomiting in three [ 5 % ] , and diarrhoea in one [ 2 % ] ) . No treatment-related deaths were reported . INTERPRETATIONS The R-GemOx regimen shows high efficacy and safety as a front-line treatment in an elderly patient sub population and might be a therapeutic option for management of diffuse large B-cell lymphoma in elderly patients . FUNDING National Natural Science Foundation of China , Jiangsu Province 's Medical Elite Programme , Project of National Key Clinical Specialty , National Science & Technology Pillar Program , Jiangsu Provincial Special Program of Medical , and National Science and Technology Major Project PURPOSE The treatment of patients with diffuse large B-cell lymphoma ( DLBCL ) with cardiac comorbidity is problematic , because this group may not be able to receive anthracycline-containing chemoimmunotherapy . We design ed a single-arm phase II multicenter trial of rituximab , gemcitabine , cyclophosphamide , vincristine , and prednisolone ( R-GCVP ) in patients considered unfit for anthracycline-containing chemoimmunotherapy because of cardiac comorbidity . PATIENTS AND METHODS Sixty-one of 62 patients received R-GCVP  , administered on day 1 with gemcitabine repeated on day 8 of a 21-day cycle . Median age was 76.5 years . All patients had advanced disease ; 27 ( 43.5 % ) had left ventricular ejection fraction of ≤ 50 % , and 35 ( 56.5 % ) had an ejection fraction of > 50 % and comorbid cardiac risk factors such as ischemic heart disease , diabetes mellitus , or hypertension [ Corrected ] . Primary end point was overall response rate at the end of treatment . RESULTS Thirty-eight patients ( 61.3 % ; 95 % CI , 49.2 to 73.4 ) achieved disease response ( complete response [ CR ] , n = 18 ; undocumented/unconfirmed CR , n = 6 ; partial response , n = 14 ) . Two-year progression-free survival for all patients was 49.8 % ( 95 % CI , 37.3 to 62.3 ) , and 2-year overall survival was 55.8 % ( 95 % CI , 43.3 to 68.4 ) . Thirty-four patients experienced grade ≥ 3 hematologic toxicity . There were 15 cardiac events , of which seven were grade 1 to 2 , five were grade 3 to 4 , and three were fatal , reflecting the poor cardiac status of the study population . CONCLUSION Our phase II multicenter trial showed that the R-GCVP regimen is an active , reasonably well-tolerated treatment for patients with DLBCL for whom anthracycline-containing immunochemotherapy was considered unsuitable because of coexisting cardiac disease BACKGROUND Diffuse large B-cell lymphoma is a common cancer in elderly patients . Although treatment has been st and ardised in younger patients , no prospect i ve study has been done in patients over 80 years old . We aim ed to investigate the efficacy and safety of a decreased dose of CHOP ( doxorubicin , cyclophosphamide , vincristine , and prednisone ) chemotherapy with a conventional dose of rituximab in elderly patients with diffuse large B-cell lymphoma . METHODS We did a prospect i ve , multicentre , single-arm , phase 2 study of patients aged over 80 years who had diffuse large B-cell lymphoma . Patients were included from 38 centres in France and Belgium . All patients received six cycles of rituximab combined with low-dose CHOP ( R-miniCHOP ) at 3-week intervals . Patients received 375 mg/m(2 ) rituximab , 400 mg/m(2 ) cyclophosphamide , 25 mg/m(2 ) doxorubicin , and 1 mg vincristine on day 1 of each cycle , and 40 mg/m(2 ) prednisone on days 1 - 5 . The primary endpoint was overall survival , both unadjusted and adjusted for treatment and baseline prognostic factors . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , NCT01087424 . FINDINGS 150 patients were enrolled between Jan 9 , 2006 , and Jan 23 , 2009 and 149 were included in the intention-to-treat analyses . Median age was 83 years ( range 80 - 95 ) . After a median follow-up of 20 months ( range 0 - 45 ) , the median overall survival was 29 months ( 95 % CI 21 to upper limit not reached ) ; 2-year overall survival was 59 % ( 49 - 67 % ) . In multivariate analyses , overall survival was only affected by a serum albumin concentration of 35 g/L or less ( hazard ratio 3·2 , 95 % CI 1·4 - 7·1 ; p=0·0053 ) . Median progression-free survival was 21 months ( 95 % CI 13 to upper limit not reached ) , with a 2-year progression free survival of 47 % ( 38 - 56 ) . 58 deaths were reported , 33 of which were secondary to lymphoma progression . 12 deaths were attributed to toxicity of the treatment . The most frequent side-effect was haematological toxicity ( grade ≥3 neutropenia in 59 patients ; febrile neutropenia in 11 patients ) . INTERPRETATION R-miniCHOP offers a good compromise between efficacy and safety in patients aged over 80 years old . R-miniCHOP should be considered as the new st and ard treatment in this subgroup of patients . FUNDING Groupe d'Etude des Lymphomes de l'Adulte ( GELA ) Abstract We conducted a prospect i ve study to compare epirubicin , cyclophosphamide , vinblastine , prednisone and rituximab ( R-miniCEOP ) with cyclophosphamide , doxorubicin , vincristine , prednisone and rituximab ( R-CHOP ) for the treatment of “ fit ” elderly patients with diffuse large B-cell lymphoma ( DLBCL ) . Patients over the age of 65 with stage II – IV DLBCL were screened with a comprehensive geriatric assessment . Patients were r and omized to receive six courses of R-miniCEOP ( n = 114 ) or R-CHOP ( n = 110 ) . Overall , the rate of complete remission was 70 % ( p = 0.466 ) . After a median follow-up of 42 months , 5-year event-free survival ( EFS ) rates were 46 % and 48 % for R-miniCEOP and R-CHOP , respectively ( p = 0.538 ) . Patients older than 72 years and with low-risk disease had a better outcome when treated with R-miniCEOP ( p = 0.011 ) . Overall R-CHOP and R-miniCEOP are similarly effective for elderly “ fit ” patients with DLBCL . The less intense R-miniCEOP may be an acceptable option for the treatment of relatively older patients with low-risk disease 
    Output:
    
CGA was first used in lymphoma trials almost 20 years ago , and growing evidence supports its use to select and stratify elderly patients with diffuse large B-cell lymphoma for curative treatment , but it is still underused in everyday practice .
A systematic review of 15 published studies , including around 11 000 elderly patients with diffuse large B-cell lymphoma , showed that CGA accurately predicts survival and tolerability , and distinguishes good c and i date s for therapy based on anthracycline and rituximab with curative intent from those patients who should receive palliative treatment .
Treating every elderly patient with an anthracyclinefree combination without pre-treatment selection might result in under-treatment of those patients who would be good c and i date s for anthracycline– rituximab therapy with curative intent .
This point is also suggested by meta-analyses of thous and s of elderly patients with diffuse large B-cell lymphoma showing that R-CHOP , compared with anthracyclinefree regimens , is associated with improved survival , even among patients older than 80 years .