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Jelicic J, Larsen TS, Andjelic B, Juul-Jensen K, Bukumiric Z. Should we use nomograms for risk predictions in diffuse large B cell lymphoma patients? A systematic review. Crit Rev Oncol Hematol 2024; 196:104293. [PMID: 38346460 DOI: 10.1016/j.critrevonc.2024.104293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Models based on risk stratification are increasingly reported for Diffuse large B cell lymphoma (DLBCL). Due to a rising interest in nomograms for cancer patients, we aimed to review and critically appraise prognostic models based on nomograms in DLBCL patients. A literature search in PubMed/Embase identified 59 articles that proposed prognostic models for DLBCL by combining parameters of interest (e.g., clinical, laboratory, immunohistochemical, and genetic) between January 2000 and 2024. Of them, 40 studies proposed different gene expression signatures and incorporated them into nomogram-based prognostic models. Although most studies assessed discrimination and calibration when developing the model, many lacked external validation. Current nomogram-based models for DLBCL are mainly developed from publicly available databases, lack external validation, and have no applicability in clinical practice. However, they may be helpful in individual patient counseling, although careful considerations should be made regarding model development due to possible limitations when choosing nomograms for prognostication.
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Affiliation(s)
- Jelena Jelicic
- Department of Hematology, Sygehus Lillebaelt, Vejle, Denmark; Department of Hematology, Odense University Hospital, Odense, Denmark.
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bosko Andjelic
- Department of Haematology, Blackpool Victoria Hospital, Lancashire Haematology Centre, Blackpool, United Kingdom
| | - Karen Juul-Jensen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Zoran Bukumiric
- Department of Statistics, Faculty of Medicine, University of Belgrade, Serbia
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Hamadani M, Spira A, Zhou X, Liao L, Chen L, Radford J, Ai W, Solh M, Ardeshna KM, Hess B, Caimi PF, Stathis A, Carlo-Stella C, Alderuccio JP, Kahl B, Wang Y, Qin Y, Xu ZC, Zinzani PL. Clinical outcomes of older and younger patients treated with loncastuximab tesirine in the LOTIS-2 clinical trial. Blood Adv 2024; 8:93-98. [PMID: 37871303 PMCID: PMC10787240 DOI: 10.1182/bloodadvances.2023010636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Affiliation(s)
- Mehdi Hamadani
- Division of Hematology and Oncology, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | | | - Xiaolei Zhou
- RTI Health Solutions, Research Triangle Park, NC
| | - Laura Liao
- ADC Therapeutics America Inc, Murray Hill, NJ
| | - Lei Chen
- ADC Therapeutics America Inc, Murray Hill, NJ
| | - John Radford
- NIHR Clinical Research Facility, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Weiyun Ai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Melhem Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Kirit M. Ardeshna
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brian Hess
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Paolo F. Caimi
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Oncology and Hematology, Humanitas Research Hospital−IRCCS, Milan, Italy
| | - Juan Pablo Alderuccio
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Brad Kahl
- Division of Oncology, Washington University, St. Louis, MO
| | - Ying Wang
- ADC Therapeutics America Inc, Murray Hill, NJ
| | - Yajuan Qin
- ADC Therapeutics America Inc, Murray Hill, NJ
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
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Niiyama-Uchibori Y, Okamoto H, Miyashita A, Mizuhara K, Kanayama-Kawaji Y, Fujino T, Tsukamoto T, Mizutani S, Shimura Y, Teramukai S, Kuroda J. Skeletal muscle index impacts the treatment outcome of elderly patients with diffuse large B cell lymphoma. Hematol Oncol 2024; 42:e3252. [PMID: 38287527 DOI: 10.1002/hon.3252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 01/31/2024]
Abstract
Sarcopenia is a crucial factor in the physical fitness of elderly individuals. This study investigated the prognostic values of multiple parameters of sarcopenia in association with established prognostic factors in elderly Japanese patients with diffuse large B cell lymphoma (DLBCL). As candidate indicators for sarcopenia, the skeletal muscle index (SMI) (cm2 /m2 ), the psoas muscle index, the erector spinae muscle index, the visceral fat index, the subcutaneous fat index, and the visceral to subcutaneous fat area ratio at the third lumbar level were assessed by computed tomography at their initial diagnosis in 102 patients with DLBCL over 75 years old those were diagnosed and treated in our institute from 2007 to 2020. The primary endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). The median age of patients analyzed was 80 years at diagnosis. The sex-specific cut-offs for the indices adopted two approaches: (i) the historical cut-off values established in the previous study for healthy Japanese individuals (Hamaguchi Y. J Cachexia Sarcopenia Muscle. 2018), and (ii) each sex-specific lowest quartile in our cohort. As the results, SMI evaluated by the historical cut-off and sex-specific lowest quartile was identified as the most influential independent prognostic factor for both OS and PFS among various parameters for sarcopenia. Furthermore, we developed an elderly sarcopenia prognostic index (ESPI). ESPI, which combines SMI evaluated by the historical cut-off and LDH > ULN, demonstrated statistically significant prognostic impacts on OS and PFS. Moreover, compared to the R-IPI, ESPI showed the ability to identify intermediate-risk groups and indicated a trend toward improved predictive accuracy. Our study revealed that SMI is the most appropriate assessment method for evaluating sarcopenia and the critical prognostic factor in OS and PFS of elderly patients with DLBCL.
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Affiliation(s)
- Yui Niiyama-Uchibori
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Haruya Okamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihiro Miyashita
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kentaro Mizuhara
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuka Kanayama-Kawaji
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahiro Fujino
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taku Tsukamoto
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Mizutani
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Shimura
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Blood Transfusion, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Saglam B, Albayrak M, Yıldız A, Tığlıoğlu P, Tığlıoğlu M, Aras MR, Yilmaz F, Maral S, A Öztürk HB. The prognostic impact of comorbidity, nutritional and performance status on patients with diffuse large B cell lymphoma. Niger J Clin Pract 2023; 26:1512-1518. [PMID: 37929528 DOI: 10.4103/njcp.njcp_175_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background The aim of the study was to investigate the impact of nutritional status, comorbidity, and performance status on patients with diffuse large B-cell lymphoma (DLBCL). Methods A retrospective study was conducted on 112 DLBCL patients who were diagnosed at our center between 2009 and 2018. Demographic and disease characteristics and laboratory test results were recorded. Assessments were made using the age-adjusted Charlson comorbidity index (CCI-A) for comorbidity, albumin level for nutritional status, and Eastern Cooperative Oncology Group (ECOG) score for performance status. Results The mean age of the patients was found to be 62.63 ± 15.16 years. The ECOG score of 65 patients (69.1%) was in the range of 0-1. The mean follow-up time of the patients was determined to be 25.24 ± 25.11 months, and at the end of the follow-up period, 64 patients (57.1%) were survivors. The progression-free survival (PFS), overall survival (OS), and 5-year OS rates of those with CCI-A > 4 were found to be significantly lower than those with CCI-A score ≤4 (P < 0.05). As a result of the Cox-Regression (Backward: LR method) analysis, ECOG and albumin levels were found to be independent risk factors for both OS and PFS (P < 0.05). Conclusion This study demonstrated that CCI-A, ECOG, and nutritional status are independent prognostic markers for DLBCL patients. Initial evaluation of these patients should include all these parameters, which are easily available at the time of diagnosis.
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Affiliation(s)
- B Saglam
- Department of Hematology, Liv Hospital Gaziantep, Gaziantep, Turkey
| | - M Albayrak
- Department of Hematology, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
| | - A Yıldız
- Ministry of Health Hitit University, Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - P Tığlıoğlu
- Department of Hematology, University of Health Sciences, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - M Tığlıoğlu
- Department of Hematology, University of Health Sciences, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - M R Aras
- Department of Hematology, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
| | - F Yilmaz
- Department of Hematology, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
| | - S Maral
- Department of Hematology, Medicine Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - H B A Öztürk
- Department of Hematology, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey
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Lee S, Fujita K, Morishita T, Negoro E, Tsukasaki H, Oiwa K, Hara T, Tsurumi H, Ueda T, Yamauchi T. The Relative Dose Intensity Changes during Cycles of Standard Regimens in Patients with Diffuse Large B-Cell Lymphoma. Cancers (Basel) 2023; 15:4458. [PMID: 37760427 PMCID: PMC10526837 DOI: 10.3390/cancers15184458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
No studies have focused on the trajectory of the average relative dose intensity (ARDI) during cycles of first-line chemotherapy for patients with diffuse large B-cell lymphoma. To evaluate the impact of attenuating ARDI during cycles on overall survival, we conducted a multi-centre, longitudinal, observational retrospective study. A total of 307 analysable patients were enrolled. Multivariate Cox hazards modelling with restricted cubic spline models revealed prognostic benefits of higher ARDI up to, but not after, cycle 6. According to group-based trajectory modelling, patients were classified into five groups depending on the pattern of ARDI changes. Among these, two groups in which ARDI had fallen significantly to less than 50% by cycles 4-6 displayed significantly poorer prognosis, despite increased ARDI in the second half of the treatment period (log-rank p = 0.02). The Geriatric Nutritional Risk Index offered significant prediction of unfavourable ARDI changes (odds ratio 2.540, 95% confidence interval 1.020-6.310; p = 0.044). Up to cycle 6, maintenance of ARDI in all cycles (but particularly in the early cycles) is important for prognosis. Malnutrition is a significant factor that lets patients trace patterns of ARDI changes during cycles of chemotherapy associated with untoward prognosis.
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Affiliation(s)
- Shin Lee
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (S.L.); (K.F.)
- Department of Hematology and Oncology, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Kei Fujita
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (S.L.); (K.F.)
- Department of Hematology and Oncology, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Tetsuji Morishita
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan;
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Eiju Negoro
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (S.L.); (K.F.)
- Department of Cancer Care Promotion Center, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan
| | - Hikaru Tsukasaki
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (S.L.); (K.F.)
- Department of Hematology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Kana Oiwa
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (S.L.); (K.F.)
- Department of Internal Medicine, Osu Hospital, Nagoya 460-0017, Japan
| | - Takeshi Hara
- Department of Hematology and Oncology, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Hisashi Tsurumi
- Department of Hematology and Oncology, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Takanori Ueda
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (S.L.); (K.F.)
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (S.L.); (K.F.)
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Yagi Y, Kanemasa Y, Sasaki Y, Goto S, Yamamura Y, Ishimine K, Hayashi Y, Mino M, Ohigashi A, Morita Y, Tamura T, Nakamura S, Okuya T, Shimoyama T. Utility of the frailty score for predicting prognosis and individualizing treatment intensity in elderly patients with diffuse large B cell lymphoma. Ann Hematol 2023; 102:1485-1500. [PMID: 37115298 DOI: 10.1007/s00277-023-05233-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
The optimal dose intensity of chemotherapy for elderly patients with diffuse large B cell lymphoma (DLBCL) remains controversial because of concerns about adverse events and comorbidities related to the patients' frailty. This single-center study retrospectively analyzed patients aged ≥ 70 years who were newly diagnosed with DLBCL and received chemotherapy between 2004 and 2022. Survival outcomes and treatment-related mortality (TRM) were stratified according to geriatric assessment variables, and the influence of chemotherapy dose intensity on outcomes was assessed using the frailty score with a Cox hazards model with restricted cubic spline (RCS) in patients aged 70-79 years. In total, 337 patients were included. The frailty score accurately predicted prognosis (5-year overall survival [OS]: 73.1%, 60.2%, and 29.7% in fit, unfit, and frail patients, respectively; P < 0.001) and TRM (5-year TRM: 0%, 5.4%, and 16.8 in fit, unfit, and frail patients, respectively; P < 0.001). Cox regression with RCS demonstrated a linear association between dose intensity and survival outcomes. Initial dose intensity (IDI) and relative dose intensity (RDI) had a significant impact on OS in fit patients. However, IDI and RDI had no significant effect on survival in non-fit (unfit and frail) patients. The frailty score identified non-fit patients with poorer survival and a higher risk of TRM. While fit patients were likely to benefit from full-dose R-CHOP, unfit and frail patients would likely benefit more from attenuated R-CHOP. This study suggested a potential role for the frailty score in individualizing treatment intensity in elderly patients with DLBCL.
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Affiliation(s)
- Yu Yagi
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yusuke Kanemasa
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
| | - Yuki Sasaki
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Sotaro Goto
- Department of Pharmacy, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yasuhiko Yamamura
- Department of Pharmacy, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kento Ishimine
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yudai Hayashi
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Mano Mino
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - An Ohigashi
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuka Morita
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Taichi Tamura
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shohei Nakamura
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Toshihiro Okuya
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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Smith MJ, Belot A, Quartagno M, Luque Fernandez MA, Bonaventure A, Gachau S, Benitez Majano S, Rachet B, Njagi EN. Excess Mortality by Multimorbidity, Socioeconomic, and Healthcare Factors, amongst Patients Diagnosed with Diffuse Large B-Cell or Follicular Lymphoma in England. Cancers (Basel) 2021; 13:5805. [PMID: 34830964 PMCID: PMC8616469 DOI: 10.3390/cancers13225805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022] Open
Abstract
(1) Background: Socioeconomic inequalities of survival in patients with lymphoma persist, which may be explained by patients' comorbidities. We aimed to assess the association between comorbidities and the survival of patients diagnosed with diffuse large B-cell (DLBCL) or follicular lymphoma (FL) in England accounting for other socio-demographic characteristics. (2) Methods: Population-based cancer registry data were linked to Hospital Episode Statistics. We used a flexible multilevel excess hazard model to estimate excess mortality and net survival by patient's comorbidity status, adjusted for sociodemographic, economic, and healthcare factors, and accounting for the patient's area of residence. We used the latent normal joint modelling multiple imputation approach for missing data. (3) Results: Overall, 15,516 and 29,898 patients were diagnosed with FL and DLBCL in England between 2005 and 2013, respectively. Amongst DLBCL and FL patients, respectively, those in the most deprived areas showed 1.22 (95% confidence interval (CI): 1.18-1.27) and 1.45 (95% CI: 1.30-1.62) times higher excess mortality hazard compared to those in the least deprived areas, adjusted for comorbidity status, age at diagnosis, sex, ethnicity, and route to diagnosis. (4) Conclusions: Deprivation is consistently associated with poorer survival among patients diagnosed with DLBCL or FL, after adjusting for co/multimorbidities. Comorbidities and multimorbidities need to be considered when planning public health interventions targeting haematological malignancies in England.
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Affiliation(s)
- Matthew James Smith
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.B.); (M.A.L.F.); (S.B.M.); (B.R.); (E.N.N.)
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.B.); (M.A.L.F.); (S.B.M.); (B.R.); (E.N.N.)
| | - Matteo Quartagno
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London WC1V 6LJ, UK;
| | - Miguel Angel Luque Fernandez
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.B.); (M.A.L.F.); (S.B.M.); (B.R.); (E.N.N.)
- Noncommunicable Disease and Cancer Epidemiology Group, Instituto de Investigación Biosanitaria de Granada, Ibs.GRANADA, Andalusian School of Public Health, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health, CIBERESP), 28029 Madrid, Spain
| | - Audrey Bonaventure
- Epidemiology of Childhood and Adolescent Cancers Team, Research Centre in Epidemiology and Biostatistics (CRESS), Inserm UMR 1153, Université de Paris, 94801 Villejuif, France;
| | - Susan Gachau
- School of Mathematics, University of Nairobi, Nairobi 30197-00100, Kenya;
| | - Sara Benitez Majano
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.B.); (M.A.L.F.); (S.B.M.); (B.R.); (E.N.N.)
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.B.); (M.A.L.F.); (S.B.M.); (B.R.); (E.N.N.)
| | - Edmund Njeru Njagi
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (A.B.); (M.A.L.F.); (S.B.M.); (B.R.); (E.N.N.)
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8
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Chuang TM, Liu YC, Hsiao HH, Wang HC, Du JS, Yeh TJ, Gau YC, Ke YL, Yang CI, Lee CP, Hsu CM, Cho SF. Low Geriatric Nutritional Risk Index Is Associated with Poorer Prognosis in Elderly Diffuse Large B-Cell Lymphoma Patients Unfit for Intensive Anthracycline-Containing Therapy: A Real-World Study. Nutrients 2021; 13:nu13093243. [PMID: 34579119 PMCID: PMC8468689 DOI: 10.3390/nu13093243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Nutritional assessments, including the Geriatric Nutritional Risk Index (GNRI), have emerged as prediction tools for long-term survival in various cancers. This study aimed to investigate the therapeutic strategy and explore the prognostic factors in the elderly patients (≥65 years) with diffuse large B cell lymphoma (DLBCL). The cutoff value of the GNRI score (92.5) was obtained using the receiver operating characteristic curve. Among these patients (n = 205), 129 (62.9%) did not receive standard R–CHOP chemotherapy. Old age (≥80 years), poor performance status, low serum albumin level, and comorbidities were the major factors associated with less intensive anti-lymphoma treatment. Further analysis demonstrated that a lower GNRI score (<92.5) was linked to more unfavorable clinical features. In the patients who received non-anthracycline-containing regimens (non-R–CHOP), multivariate analysis showed that a low GNRI can serve as an independent predictive factor for worse progression-free (HR, 2.85; 95% CI, 1.05–7.72; p = 0.039) and overall survival (HR, 2.98; 95% CI, 1.02–8.90; p = 0.045). In summary, nutritional evaluation plays a role in DLBCL treatment and the GNRI score can serve as a feasible predictive tool for clinical outcomes in frail elderly DLBCL patients treated with non-anthracycline-containing regimens.
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Affiliation(s)
- Tzer-Ming Chuang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Yi-Chang Liu
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Hua Hsiao
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hui-Ching Wang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jeng-Shiun Du
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Tsung-Jang Yeh
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Yuh-Ching Gau
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Ya-Lun Ke
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Ching-I Yang
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Specialist Nurse and Surgical Nurse Practitioner Office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Ching-Ping Lee
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Chin-Mu Hsu
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
| | - Shih-Feng Cho
- Division of Hematology & Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-M.C.); (Y.-C.L.); (H.-H.H.); (H.-C.W.); (J.-S.D.); (T.-J.Y.); (Y.-C.G.); (Y.-L.K.); (C.-I.Y.); (C.-P.L.); (C.-M.H.)
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-312-1101
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9
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Oiwa K, Fujita K, Lee S, Morishita T, Tsukasaki H, Negoro E, Hara T, Tsurumi H, Ueda T, Yamauchi T. Prognostic impact of six versus eight cycles of standard regimen in patients with diffuse large B-cell lymphoma: propensity score-matching analysis. ESMO Open 2021; 6:100210. [PMID: 34271313 PMCID: PMC8287142 DOI: 10.1016/j.esmoop.2021.100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background R-CHOP-21 has been the standard treatment for diffuse large B-cell lymphoma (DLBCL), but there is a paucity of evidence focusing on the number of cycles of regimens. Patients and methods We conducted a retrospective study to compare the effectiveness of six cycles of standard regimens versus eight cycles for overall survival (OS) in DLBCL patients using propensity score matching, in consideration of relative dose intensity (RDI). Results A total of 685 patients with newly diagnosed DLBCL were identified in three institutions from 2007 to 2017. Patients treated using six cycles of standard regimens were matched by propensity scores with those treated using eight cycles. A 1 : 1 propensity score matching yielded 138 patient pairs. Eight cycles did not significantly improve OS in the conventional Cox proportional hazards model (hazard ratio 0.849, 95% confidence interval 0.453-1.588, P = 0.608). Restricted cubic spline Cox models for OS confirmed that the effect of the number of cycles was not modified by total average RDI, the International Prognostic Index, and age. Occurrence of adverse events did not differ between six and eight cycles. Conclusion Even considering the impact of RDI, six cycles of the initial standard regimen for DLBCL is not inferior to eight cycles. The optimal number of cycles of standard regimens including R-CHOP-21 for newly diagnosed DLBCL has not been determined. This study was conducted to verify whether six cycles or eight cycles of standard regimen improved the prognosis of DLBCL. Propensity score matching and a Cox hazards model with restricted cubic spline were used in this study. No survival benefit of eight cycles compared with six cycles was seen, even taking into account RDI. Prognosis was no better with eight cycles of (R-)CHOP-21 or THP-COP-21 than with six cycles, after age and IPI modifications.
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Affiliation(s)
- K Oiwa
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology and Oncology, Nagoya City University, Aichi, Japan
| | - K Fujita
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - S Lee
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology, Matsunami General Hospital, Gifu, Japan.
| | - T Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Kyoto, Japan
| | - H Tsukasaki
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan; Department of Hematology, Fukui Red Cross Hospital, Fukui, Japan
| | - E Negoro
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
| | - T Hara
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - H Tsurumi
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - T Ueda
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
| | - T Yamauchi
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
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10
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Lee S, Fujita K, Morishita T, Oiwa K, Tsukasaki H, Negoro E, Hara T, Tsurumi H, Ueda T, Yamauchi T. Association of the Geriatric 8 with treatment intensity and prognosis in older patients with diffuse large B-cell lymphoma. Br J Haematol 2021; 194:325-335. [PMID: 34041751 DOI: 10.1111/bjh.17554] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/23/2021] [Indexed: 01/12/2023]
Abstract
Because of the heterogeneity among older patients with diffuse large B-cell lymphoma (DLBCL), the establishment of an easy-to-use geriatric assessment tool is an unmet need. We verified the impact of the Geriatric 8 (G8) on treatment stratification and overall survival (OS). We conducted a retrospective, multicentre analysis of older patients (≥65 years) with DLBCL. The primary endpoint was OS. The total average relative dose intensity (tARDI) was defined as the average delivered dose intensity divided by the planned dose intensity through all cycles. A total of 451 patients were diagnosed with DLBCL from 2007 to 2017, and 388 patients received standard regimens. A multivariate Cox model confirmed that the G8 was a significant predictor of OS (hazard ratio 0·88, 95% confidence interval 0·828-0·935). A Cox model with restricted cubic spline showed a linear association between the G8 and the mortality risk. The G8 had a significant impact on OS in elderly patients with DLBCL. The upper limit of tARDI for standard regimens to improve OS might be appropriate at ≥80% for patients with high G8 scores and 60% for patients with low G8 scores. However, the standard regimens should be given to all patients regardless of the G8 score to improve OS.
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Affiliation(s)
- Shin Lee
- Department of Hematology, Matsunami General Hospital, Gifu, Japan.,Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kei Fujita
- Department of Hematology, Matsunami General Hospital, Gifu, Japan.,Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuji Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Kyoto, Japan
| | - Kana Oiwa
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Hematology and Oncology, Nagoya City University, Aichi, Japan
| | - Hikaru Tsukasaki
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Hematology, Fukui Red Cross Hospital, Fukui, Japan
| | - Eiju Negoro
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takeshi Hara
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Hisashi Tsurumi
- Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Takanori Ueda
- Department of Hematology, Matsunami General Hospital, Gifu, Japan.,Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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11
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Hu Y, Xu YJ, Li MZ, Lan YX, Mao L, Ning QY, Xu W, Yang HL, Zhang YZ. [The prognostic impact of diabetic mellitus and hyperglycemia during DLBCL treatment on patients with diffuse large B-cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:151-157. [PMID: 33858047 PMCID: PMC8071671 DOI: 10.3760/cma.j.issn.0253-2727.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
目的 探讨弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征和预后因素,评估合并糖尿病(DM)及治疗过程中发生血糖升高对DLBCL预后的影响。 方法 回顾性收集2009年1月1日至2019年12月31日天津医科大学肿瘤医院及中山大学肿瘤防治中心收治的481例初诊DLBCL患者的临床资料,重点关注其治疗前及治疗中的血糖水平,采用Cox回归风险模型进行单因素分析评估预后影响因素,采用Kaplan-Meier法绘制生存曲线分析血糖异常对DLBCL患者总生存(OS)、无进展生存(PFS)的影响。 结果 82例(17.0%)患者在诊断DLBCL前患DM,88例(18.3%)患者在DLBCL治疗过程中至少发生一次血糖升高。单因素分析显示,年龄、Ann-Arbor分期、IPI评分、是否合并DM与OS、PFS相关(P值均<0.05)。组间比较显示,合并DM组与治疗过程中血糖升高组的OS和PFS均较无血糖异常组差(OS:P值分别为0.001、0.003,PFS:P值均<0.001),合并DM组与治疗过程中血糖升高组相比OS和PFS的差异均无统计学意义(P值分别为0.557、0.463)。化疗期间血糖控制良好组的OS和PFS优于血糖控制差组(OS:P=0.037,PFS:P=0.007)。 结论 合并DM是影响DLBCL患者预后的重要因素,治疗过程中血糖升高与DLBCL患者的不良预后相关。
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Affiliation(s)
- Y Hu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Y J Xu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - M Z Li
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Y X Lan
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - L Mao
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Q Y Ning
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - W Xu
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - H L Yang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Y Z Zhang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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12
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Oiwa K, Fujita K, Lee S, Morishita T, Tsukasaki H, Negoro E, Ueda T, Yamauchi T. Utility of the Geriatric 8 for the Prediction of Therapy-Related Toxicity in Older Adults with Diffuse Large B-Cell Lymphoma. Oncologist 2020; 26:215-223. [PMID: 33320984 DOI: 10.1002/onco.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The management of severe adverse events (AEs) is important in safely and effectively providing chemotherapy to older adults with diffuse large B-cell lymphoma (DLBCL). However, reports on simple and DLBCL-specific predictive models for treatment-related toxicity in elderly individuals are scarce. The aim of this study was to examine the usefulness of Geriatric 8 (G8) in predicting treatment-related severe AEs, nonhematological toxicity, and febrile neutropenia in older adults with DLBCL in real-world practice. MATERIALS AND METHODS We conducted a multicenter, retrospective study on 398 consecutive patients with DLBCL (aged ≥65 years) who received standard therapy at three centers in Japan (University of Fukui Hospital, the Fukui Prefectural Hospital, and the Japanese Red Cross Fukui Hospital), between 2007 and 2017. RESULT Multivariate logistic analysis demonstrated that the G8 score was an independent predictive factor for severe AEs. Moreover, a logistic regression model with restricted cubic spline showed a nonlinear association between the incidence of severe AEs and the G8 score. According to receiver operating characteristic analysis, the most discriminative cutoff value of the G8 for the incidence of severe AEs was 11, with an area under the curve value of 0.670. AEs occurred most often in the first course of chemotherapy and decreased as the course progressed. CONCLUSION The G8 score, an easy-to-use geriatric assessment tool, can be a useful prediction model of treatment-related severe AEs during standard therapy in older adults with DLBCL. IMPLICATIONS FOR PRACTICE In older patients with diffuse large B-cell lymphoma (DLBCL), to accurately predict the risk of severe adverse events (AEs) in advance is essential for safe and effective treatment. This study demonstrated that the Geriatric 8 score, a simple and established geriatric assessment tool, indicated a high predictive ability for occurrence of therapy-related severe AEs in elderly patients with DLBCL who were treated with standard treatment.
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Affiliation(s)
- Kana Oiwa
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan.,Department of Hematology and Oncology, Nagoya City University, Aichi, Japan
| | - Kei Fujita
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan.,Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Shin Lee
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan.,Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Tetsuji Morishita
- Department of Cardiovascular Medicine, University of Fukui, Fukui, Japan.,Department Cardiovascular Medicine, National Hospital Organization Awara Hospital, Fukui, Japan
| | - Hikaru Tsukasaki
- Department of Hematology, Fukui Red Cross Hospital, Fukui, Japan
| | - Eiju Negoro
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
| | - Takanori Ueda
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, University of Fukui, Fukui, Japan
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13
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Tanaka N, Imai Y, Yoshinaga K, Shiseki M, Tanaka J. Fractionated ifosfamide, carboplatin, and etoposide with rituximab as a safe and effective treatment for relapsed/refractory diffuse large B cell lymphoma with severe comorbidities. Ann Hematol 2020; 99:2577-2586. [PMID: 32945942 DOI: 10.1007/s00277-020-04267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/07/2020] [Indexed: 11/24/2022]
Abstract
Although treatment outcomes for diffuse large B cell lymphoma (DLBCL) have improved with the introduction of rituximab, approximately half of patients experience relapsed/refractory (r/r) disease. Furthermore, no standard salvage therapy has yet been established to date, while limitations in treatment options exist due to toxicity and restricted tolerability among elderly patients and/or those with comorbidities. The ICE (ifosfamide, cyclophosphamide, and etoposide) regimen is often used as salvage therapy for r/r DLBCL. Several modified ICE regimens not requiring continuous ifosfamide infusion are available, which can be used in outpatient clinics. This study analyzed the efficacy and toxicity of fractionated ICE with rituximab (f-R-ICE) as a salvage regimen among 47 patients with relapsed/refractory DLBCL (median age upon f-R-ICE initiation, 71 years). The whole cohort had an overall (ORR) and complete response rate of 53.1% (n = 25) and 25.5% (n = 12), respectively, and an estimated 1-year overall survival after f-R-ICE initiation of 57%. Comorbidities were evaluated using the Charlson Comorbidity Index (CCI) upon f-R-ICE initiation. Patients with low CCI scores (68%) had a higher ORR than those with high CCI scores (36.4%) upon f-R-ICE initiation (P = 0.042). In contrast, no significant differences in overall survival (OS) were observed between the low and high CCI groups (1-year OS 56.6% vs. 52.2%; median OS 24 vs. 22.8 months) after initiating f-R-ICE. Our results suggest that f-R-ICE is a safe and effective salvage therapy for r/r DLBCL and can be used for older patients and/or those with high CCI scores in outpatient clinics.
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Affiliation(s)
- Norina Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoichi Imai
- Department of Hematology/Oncology, Research Hospital, Institute of Medical Science, University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
| | - Kentaro Yoshinaga
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Shiseki
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
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14
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Jelicic J, Larsen TS, Frederiksen H, Andjelic B, Maksimovic M, Bukumiric Z. Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models - A Systematic Review. Clin Epidemiol 2020; 12:537-555. [PMID: 32581596 PMCID: PMC7266947 DOI: 10.2147/clep.s244294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background and Aim Based on advances in the diagnosis, classification, and management of diffuse large B-cell lymphoma (DLBCL), a number of new prognostic models have been proposed. The aim of this study was to review and compare different prognostic models of DLBCL based on the statistical methods used to evaluate the performance of each model, as well as to analyze the possible limitations of the methods. Methods and Results A literature search identified 46 articles that proposed 55 different prognostic models for DLBCL by combining different clinical, laboratory, and other parameters of prognostic significance. In addition, six studies used nomograms, which avoid risk categorization, to create prognostic models. Only a minority of studies assessed discrimination and/or calibration to compare existing models built upon different statistical methods in the process of development of a new prognostic model. All models based on nomograms reported the c-index as a measure of discrimination. There was no uniform evaluation of the performance in other prognostic models. We compared these models of DLBCL by calculating differences and ratios of 3-year overall survival probabilities between the high- and the low-risk groups. We found that the highest and lowest ratio between low- and high-risk groups was 6 and 1.31, respectively, while the difference between these groups was 18.9% and 100%, respectively. However, these studies had limited duration of follow-up and the number of patients ranged from 71 to 335. Conclusion There is no universal statistical instrument that could facilitate a comparison of prognostic models in DLBCL. However, when developing a prognostic model, it is recommended to report its discrimination and calibration in order to facilitate comparisons between different models. Furthermore, prognostic models based on nomograms are becoming more appealing owing to individualized disease-related risk estimations. However, they have not been validated yet in other study populations.
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Affiliation(s)
- Jelena Jelicic
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bosko Andjelic
- Department of Haematology, Blackpool Victoria Hospital, Lancashire Haematology Centre, Blackpool, UK
| | - Milos Maksimovic
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Zoran Bukumiric
- Department of Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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15
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Yamamoto M, Suzuki I, Saitou K, Tsumanuma R, Okuyama S, Kumagai H, Omoto E, Satoh S, Tajima K. Impact of comorbidity and relative dose intensity on outcomes in diffuse large B-cell lymphoma patients treated with R-CHOP. J Cancer Res Clin Oncol 2020; 146:2995-3002. [DOI: 10.1007/s00432-020-03279-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/30/2020] [Indexed: 12/21/2022]
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16
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Lee S, Fujita K, Morishita T, Negoro E, Oiwa K, Tsukasaki H, Yamamura O, Ueda T, Yamauchi T. Prognostic utility of a geriatric nutritional risk index in combination with a comorbidity index in elderly patients with diffuse large B cell lymphoma. Br J Haematol 2020; 192:100-109. [PMID: 32410224 DOI: 10.1111/bjh.16743] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/21/2020] [Indexed: 12/18/2022]
Abstract
Reflecting the increasing risk in elderly patients with diffuse large B cell lymphoma (DLBCL), prognostic predictors other than the International Prognostic Index have attracted more attention. This study presents the first analysis of the prognostic utility of the Geriatric Nutritional Risk Index (GNRI) in combination with the Charlson Comorbidity Index (CCI) for overall survival (OS) in elderly DLBCL patients. A multicentre retrospective was conducted on a cohort of 451 patients (≥65 years). The GNRI and CCI were independent predictors in a multivariate Cox proportional hazard model. There was a nonlinear correlation between the GNRI and OS in a Cox model with restricted cubic spline. Multivariate receiver operating characteristic curves showed a significant improvement in prediction accuracy when the GNRI was added to CCI. Adding the GNRI to CCI yielded a significant category-free net reclassification improvement (0·556; 95% CI: 0·378-0·736, P < 0·001) and integrated discrimination improvement (0·094; 95% CI: 0·067-0·122, P < 0·001). The decision curve analysis demonstrated the clinical net benefit associated with the adoption of the GNRI. The GNRI was not only a predictor of OS but also remarkably improved the prognosis prediction accuracy when incorporated with the CCI, having the ability to stratify the prognosis of elderly DLBCL patients.
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Affiliation(s)
- Shin Lee
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Kei Fujita
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Hematology, Matsunami General Hospital, Gifu, Japan
| | - Tetsuji Morishita
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Cardiovascular Medicine, National Hospital Organization Awara Hospital, Fukui, Japan
| | - Eiju Negoro
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kana Oiwa
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Department of Hematology and Oncology, Nagoya City University, Aichi, Japan
| | - Hikaru Tsukasaki
- Department of Hematology, Fukui Red Cross Hospital, Fukui, Japan
| | - Osamu Yamamura
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takanori Ueda
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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The Prognostic Impact of Comorbidities in Patients with De-Novo Diffuse Large B-Cell Lymphoma Treated with R-CHOP Immunochemotherapy in Curative Intent. J Clin Med 2020; 9:jcm9041005. [PMID: 32252438 PMCID: PMC7230391 DOI: 10.3390/jcm9041005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Patient-related factors, namely comorbidities, impact the clinical outcome of patients with diffuse large B-cell lymphoma (DLBCL). Methods: The prevalence and prognostic impact of comorbidities were examined using the validated scores Charlson Comorbidity Index (CCI) and Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) in 181 patients with DLBCL at initial diagnosis before treatment with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone (R-CHOP). Results: Pronounced comorbidities as defined by CCI and HCT-CI scoring of ≥2 were detected in 9.9% and 28.2% of patients, respectively, and occurred more frequently at advanced age (p < 0.001). Higher CCI scoring was associated with lower complete response rate (p = 0.020). Both advanced CCI and HCT-CI were significantly associated with shortened overall survival (3-year OS: CCI ≥2 vs. 0–1, 38.9% vs. 81.3%, p < 0.001; HCT-CI ≥2 vs. 0–1, 56.9% vs. 84.9%, p < 0.001). Both comorbidity scores remained independent risk factors in the multivariate analysis (HCT-CI ≥2 HR: 2.6, p = 0.004; CCI ≥2 HR: 3.6, p = 0.001). Conclusion: This study demonstrates the prognostic relevance of comorbidities classified by CCI and HCT-CI in patients with DLBCL undergoing curative treatment with R-CHOP. A structured evaluation of comorbidities might refine prognostication alongside currently used prognostic parameters, namely age, and should be evaluated in prospective trials.
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18
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Hu J, Xu J, Yu M, Gao Y, Liu R, Zhou H, Zhang W. An integrated prognosis model of pharmacogenomic gene signature and clinical information for diffuse large B-cell lymphoma patients following CHOP-like chemotherapy. J Transl Med 2020; 18:144. [PMID: 32228625 PMCID: PMC7106727 DOI: 10.1186/s12967-020-02311-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 03/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background As the most common form of lymphoma, diffuse large B-cell lymphoma (DLBCL) is a clinical highly heterogeneous disease with variability in therapeutic outcomes and biological features. It is a challenge to identify of clinically meaningful tools for outcome prediction. In this study, we developed a prognosis model fused clinical characteristics with drug resistance pharmacogenomic signature to identify DLBCL prognostic subgroups for CHOP-based treatment. Methods The expression microarray data and clinical characteristics of 791 DLBCL patients from two Gene Expression Omnibus (GEO) databases were used to establish and validate this model. By using univariate Cox regression, eight clinical or genetic signatures were analyzed. The elastic net-regulated Cox regression analysis was used to select the best prognosis related factors into the predictive model. To estimate the prognostic capability of the model, Kaplan–Meier curve and the area under receiver operating characteristic (ROC) curve (AUC) were performed. Results A predictive model comprising 4 clinical factors and 2 pharmacogenomic gene signatures was established after 1000 times cross validation in the training dataset. The AUC of the comprehensive risk model was 0.78, whereas AUC value was lower for the clinical only model (0.68) or the gene only model (0.67). Compared with low-risk patients, the overall survival (OS) of DLBCL patients with high-risk scores was significantly decreased (HR = 4.55, 95% CI 3.14–6.59, log-rank p value = 1.06 × 10−15). The signature also enables to predict prognosis within different molecular subtypes of DLBCL. The reliability of the integrated model was confirmed by independent validation dataset (HR = 3.47, 95% CI 2.42–4.97, log rank p value = 1.53 × 10−11). Conclusions This integrated model has a better predictive capability to ascertain the prognosis of DLBCL patients prior to CHOP-like treatment, which may improve the clinical management of DLBCL patients and provide theoretical basis for individualized treatment.
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Affiliation(s)
- Jinglei Hu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Jing Xu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Muqiao Yu
- Xiangya School of Stomatology, Central South University, Changsha, 410078, Human, People's Republic of China
| | - Yongchao Gao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Rong Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China. .,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China. .,Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Honghao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Wei Zhang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, People's Republic of China. .,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, 110 Xiangya Road, Changsha, 410078, People's Republic of China. .,Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha, 410078, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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19
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Drozd-Sokolowska J, Zaucha JM, Biecek P, Giza A, Kobylinska K, Joks M, Wrobel T, Kumiega B, Knopinska-Posluszny W, Spychalowicz W, Romejko-Jarosinska J, Fischer J, Wiktor-Jedrzejczak W, Dlugosz-Danecka M, Giebel S, Jurczak W. Type 2 diabetes mellitus compromises the survival of diffuse large B-cell lymphoma patients treated with (R)-CHOP - the PLRG report. Sci Rep 2020; 10:3517. [PMID: 32103128 PMCID: PMC7044262 DOI: 10.1038/s41598-020-60565-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/10/2020] [Indexed: 12/01/2022] Open
Abstract
Comorbidities impair the prognosis of diffuse large B-cell lymphoma (DLBCL). Type 2 diabetes mellitus (DMT2) increases the risk of other comorbidities, e.g., heart failure (HF). Thus, we hypothesized that pre-existing DMT2 may negatively affect the outcome of DLBCL. To verify this, DLBCL patients treated with (R)-CHOP were enrolled. 469 patients were eligible, with a median age of 57 years; 356 patients had advanced-stage DLBCL. 126 patients had high-intermediate and 83 high-risk international prognostic index (IPI). Seventy-six patients had DMT2, 46 HF; 26 patients suffered from both DMT2 and HF. In the analyzed group DMT2 or HF significantly shortened overall survival (OS) and progression free survival (PFS): the 5-year OS for patients with DMT2 was 64% vs 79% and for those with HF: 49% vs 79%. The 5-year PFS for DMT2 was 50.6% vs 62.5% and for HF 39.4% vs 63.2%. The relapse/progression incidence was comparable between groups; the non-relapse/progression mortality (NRPM) was significantly higher solely in DMT2 patients (5-year NRPM 22.5% vs 8.4%). The risk of death was higher in patients with higher IPI (HR = 1.85) and with DMT2 (HR = 1.87). To conclude, pre-existing DMT2, in addition to a higher IPI and HF, was a negative predictor for OS and PFS.
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Affiliation(s)
- Joanna Drozd-Sokolowska
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Banacha 1a Str, 02-097, Warszawa, Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology, Medical University of Gdansk, Smoluchowskiego 17 Str., 80-214, Gdansk, Poland.
| | - Przemyslaw Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 75 Str., 00-662, Warszawa, Poland
| | - Agnieszka Giza
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
| | - Katarzyna Kobylinska
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Koszykowa 75 Str., 00-662, Warszawa, Poland
| | - Monika Joks
- Department of Hematology, University of Medical Sciences of Poznan, Szamarzewskiego 84 Str., 60-569, Poznan, Poland
| | - Tomasz Wrobel
- Department of Hematology, Wroclaw Medical University, Wybrzeże L. Pasteura 4 Str., 50-367, Wroclaw, Poland
| | - Beata Kumiega
- Department of Hematooncology, Markiewicz Memorial Oncology Center Brzozow, Ks. Bielawskiego 18 Str., 36-200, Brzozow, Poland
| | - Wanda Knopinska-Posluszny
- Hematology Department, Independent Public Health Care Ministry of the Interior of Warmia and Mazury Oncology Center, Aleja Wojska Polskiego 37 Str., 10-228, Olsztyn, Poland
| | - Wojciech Spychalowicz
- Internal Medicine and Oncology Clinic, Silesian Medical University, Reymonta 8 Str., 40-027, Katowice, Poland
| | - Joanna Romejko-Jarosinska
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Roentgena 5 Str., 02-781, Warszawa, Poland
| | - Joanna Fischer
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
| | - Wieslaw Wiktor-Jedrzejczak
- Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Banacha 1a Str, 02-097, Warszawa, Poland
| | - Monika Dlugosz-Danecka
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
| | - Sebastian Giebel
- Maria Sklodowska-Curie Institute-Cancer Center, Gliwice Branch, Wybrzeże Armii Krajowej 15 Str., 44-101, Gliwice, Poland
| | - Wojciech Jurczak
- Department of Hematology, Jagiellonian University, Mikołaja Kopernika 17 Str., 30-501, Krakow, Poland
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20
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Glimelius I, Smedby KE, Eloranta S, Jerkeman M, Weibull CE. Comorbidities and sex differences in causes of death among mantle cell lymphoma patients – A nationwide population‐based cohort study. Br J Haematol 2019; 189:106-116. [DOI: 10.1111/bjh.16317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Clinical and Experimental Oncology Uppsala University and Uppsala Akademiska Hospital Uppsala Sweden
- Department of Medicine Division of Clinical Epidemiology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - Karin E. Smedby
- Department of Medicine Division of Clinical Epidemiology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Division of Hematology Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - Sandra Eloranta
- Department of Medicine Division of Clinical Epidemiology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - Mats Jerkeman
- Department of Oncology Skane University Hospital Lund Sweden
| | - Caroline E. Weibull
- Department of Medicine Division of Clinical Epidemiology Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
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21
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Zeremski V, Jentsch-Ullrich K, Kahl C, Mohren M, Eberhardt J, Fischer T, Schalk E. Is bendamustine-rituximab a reasonable treatment in selected older patients with diffuse large B cell lymphoma? Results from a multicentre, retrospective study. Ann Hematol 2019; 98:2729-2737. [PMID: 31705183 DOI: 10.1007/s00277-019-03819-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023]
Abstract
Despite bendamustine-rituximab (BR) showed disappointing efficacy in diffuse large B cell lymphoma (DLBCL), it is still occasionally used as first-line treatment in older DLBCL patients instead of recommended R-CHOP. This multicentre, retrospective study was aimed to clarify circumstances in which BR may be justified in this setting. Patients ≥ 65 years with ECOG performance status (PS) ≥ 2 or ≥ 75 years regardless of PS were included. A total of 140 patients were analysed (BR, 68; R-CHOP, 72). BR patients were older (p < 0.001) and were diagnosed more often with high-risk disease (p = 0.03); no difference regarding comorbidities or PS was seen. Compared with R-CHOP, BR was associated with marked inferior overall survival (OS) (16.3 vs. 75.4 months; p = 0.006) and progression-free survival (PFS) (11.0 vs. 62.3 months; p < 0.001). In multivariate analysis, only high age-adjusted Charlson Comorbidity Index (aaCCI) was associated with inferior PFS in R-CHOP patients (hazard ratio 2.67; p = 0.012). Comparing the subgroup of BR and R-CHOP patients with high aaCCI, there was no difference in OS (p = 0.73) or PFS (p = 0.75). Due to the observed non-superiority of R-CHOP in older DLBCL patients with comorbidities, we propose that this subgroup may be treated alternatively with BR, whereas all other older patients are clearly R-CHOP candidates.
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Affiliation(s)
- Vanja Zeremski
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
- Health Campus Immunology, Infectiology and Inflammation (GC-I3), Medical Centre, Otto-von-Guericke University, Magdeburg, Germany.
| | | | - Christoph Kahl
- Department of Haematology, Oncology and Palliative Care, Klinikum Magdeburg, Magdeburg, Germany
| | - Martin Mohren
- Department of Hematology and Oncology, Johanniter Krankenhaus, Stendal, Germany
| | - Judith Eberhardt
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GC-I3), Medical Centre, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Fischer
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GC-I3), Medical Centre, Otto-von-Guericke University, Magdeburg, Germany
| | - Enrico Schalk
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Health Campus Immunology, Infectiology and Inflammation (GC-I3), Medical Centre, Otto-von-Guericke University, Magdeburg, Germany
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22
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Morrison VA, Hamilton L, Ogbonnaya A, Raju A, Hennenfent K, Galaznik A. Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma - Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007-2015. J Geriatr Oncol 2019; 11:41-54. [PMID: 31416716 DOI: 10.1016/j.jgo.2019.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/27/2019] [Accepted: 07/30/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We characterized real-world treatment patterns in older (65-74 years) and oldest (75-85 years) patients with diffuse large B-cell lymphoma (DLBCL) receiving initial therapy (R-CHOP, non-R-CHOP regimens). Impact of comorbidities on treatment choice, and overall and progression-free survival (OS, PFS) were assessed by age. PATIENTS AND METHODS Using the Humedica database, we identified 1436 newly diagnosed patients with DLBCL who received frontline therapy from 1/07-9/15. The 885 patients ≥65 years of age were further evaluated for baseline demographics, comorbidities, initial therapy, and PFS/OS. RESULTS Of 885 patients, 406 (45.9%) were age 65-74, and 479 (54.1%) age 75-85, years. First line therapy was R-CHOP (61.8%) or non-R-CHOP (38.2%). Although Charlson Comorbidity Index (CCI) scores were similar at baseline, congestive heart failure and myocardial infarction were more common in those receiving non-R-CHOP regimens. Survival outcomes were superior for those receiving initial R-CHOP, versus non-R-CHOP, therapy (median PFS 53.9 versus 27.8 months; two-year PFS 71.2% versus 51.6%, p < .0001; median OS not reached versus 45 months; two-year OS 81.3% versus 62.9%, p < .0001, respectively). Only 10.4% (R-CHOP) and 12.1% (non-R-CHOP) of patients received second line therapies. Two-year OS by age (65-74, 75-85 years) was 66.4% and 39.1%, respectively with R-CHOP (p = .0045), and 74.3% and 54.5%, respectively with non-R-CHOP (p = .004), therapy. Age ≥ 75 years and CCI of 2+ were associated with shorter OS and PFS. CONCLUSIONS This study identified real-world first line treatment patterns for older patients with DLBCL. Our findings support the feasibility of administering standard R-CHOP therapy, even to oldest patients with DLBCL.
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Affiliation(s)
- Vicki A Morrison
- Hematology/Oncology, Hennepin County Medical Center, University of Minnesota, 715 8th St, Minneapolis, MN 55404, USA.
| | - Laurie Hamilton
- Xcenda LLC, 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, USA.
| | | | - Aditya Raju
- Xcenda LLC, 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, USA.
| | - Kristin Hennenfent
- Xcenda LLC, 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, USA.
| | - Aaron Galaznik
- Millennium Pharmaceuticals, Inc., 40 Landsdowne St, Cambridge, MA 02139, USA(1).
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23
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Wästerlid T, Mohammadi M, Smedby KE, Glimelius I, Jerkeman M, Bottai M, Eloranta S. Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B-cell lymphoma: a Swedish lymphoma register study. J Intern Med 2019; 285:455-468. [PMID: 30368947 DOI: 10.1111/joim.12849] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comorbidity impacts overall survival amongst patients with diffuse large B-cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma-specific mortality are less well known. OBJECTIVE To examine the impact of comorbidity on DLBCL characteristics, treatment intent and cause of death. METHODS We identified 3905 adult patients diagnosed with DLBCL 2007-2013 through the Swedish Lymphoma Register. We assessed comorbid disease history according to the Charlson comorbidity index (CCI). Comorbidity data and causes of death were collected through register linkage. Associations were estimated using multinomial regression and flexible parametric survival models. RESULTS Overall, 45% of the patients (n = 1737) had a history of at least one comorbidity at DLBCL diagnosis (cardiovascular disease, diabetes and solid cancer were most frequent), and 997 (26%) had a CCI score of ≥2. The relative probability of presenting with poor performance status (PS > 2) was higher amongst comorbid patients [Relative Risk Ratio (RRR)PS>2 : 2.02, 95% CI: 1.63-2.51]. Comorbid patients had a substantially lower relative probability of receiving curative treatment (RRR: 0.48, 95% CI: 0.38-0.61). Amongst all patients, CCI ≥ 1 was associated with a significantly increased risk of all-cause and lymphoma-specific death after adjustments. Amongst patients selected for curative treatment, comorbidity was associated with an increased risk of all-cause death (HRCCI>1 : 1.54, 95% CI: 1.32-1.80), but not with lymphoma-specific death (HRCCI>1 : 1.05, 95% CI: 0.86-1.28). CONCLUSION Comorbidity is associated with inferior DLBCL outcome, mainly due to a lower likelihood of receiving treatment with curative intent. Possibly, more comorbid DLBCL patients could be treated with curative intent if comorbid conditions were optimized in parallel.
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Affiliation(s)
- T Wästerlid
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - M Mohammadi
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - K E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - I Glimelius
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden
| | - M Jerkeman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - M Bottai
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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24
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Jelicic J, Larsen TS, Maksimovic M, Trajkovic G. Available prognostic models for risk stratification of diffuse large B cell lymphoma patients: a systematic review. Crit Rev Oncol Hematol 2018; 133:1-16. [PMID: 30661646 DOI: 10.1016/j.critrevonc.2018.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022] Open
Abstract
The International Prognostic Index (IPI) has been used for risk stratification for a long time in diffuse large B cell lymphoma (DLBCL). Based on new clinical and biological prognostic markers, many new prognostic models have been described. This review aims to present the progress in development and validation of these prognostic models. A comprehensive literature review was performed to identify studies that proposed a new prognostic model in DLBCL. A total of 38 studies met the inclusion criteria. The IPI, revised IPI (R-IPI), and National Comprehensive Cancer Network (NCCN)-IPI were the most studied prognostic indexes, externally validated and commonly used to compare to other models. Despite an increasing number of prognostic models have been proposed lately, most of them lack external validation. Further studies, that combine biological and clinical markers with prognostic significance, are needed to determine the optimal prognostic tool for more personalized treatment approach to DLBCL patients.
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Affiliation(s)
- Jelena Jelicic
- Clinic for Haematology, Clinical Centre of Serbia, Dr Koste Todorovica 2, 11000, Belgrade, Serbia
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, Sdr. Boulevard 29, Indgang 85 Pavillon, 5000, Odense C, Denmark.
| | - Milos Maksimovic
- Clinic for Ophthalmology, Clinical Centre of Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - Goran Trajkovic
- Department of Statistics, Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia
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25
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Vick EJ, Richardson N, Patel K, Delgado Ramos GM, Altahan A, Alloway T, Martin MG. Age-Related Chromosomal Aberrations in Patients with Diffuse Large B-Cell Lymphoma: An In Silico Approach. World J Oncol 2018; 9:97-103. [PMID: 30220946 PMCID: PMC6134989 DOI: 10.14740/wjon1136w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/27/2018] [Indexed: 02/05/2023] Open
Abstract
Background In diffuse large B-cell lymphoma (DLBCL), chromosomal aberrations are known to increase with advancing age. Our study aims to determine if there are other genetic aberrations associated with DLBCL based on age. Methods Using the Mitelman Database of Genetic Aberrations, we were able to find 749 cases of DLBCL with genomic aberrations with a median age of 62 years. Patients with DLBCL chromosomal aberration analysis results were divided into four groups based on age (0 - 30, 31 - 50, 51 - 70, > 71 years) and examined by chi-square analysis and Mantel-Cox for survival analysis. Results Ten aberrations were found to be significant with a particular age range: t(2;3), trisomy 19p13, trisomy 18q21, trisomy 3, trisomy 7, trisomy 14, trisomy 16, trisomy 18, monosomy 3 and monosomy 11, and survival ranged from 7 to 25 months. Conclusion This suggests that patients with DLBCL are likely to accumulate specific translocations depending on their age at the onset of DLBCL.
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Affiliation(s)
- Eric J. Vick
- Department of Internal Medicine, University of Cincinnati, Cincinnati OH, USA
| | - Noah Richardson
- College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kruti Patel
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Glenda M. Delgado Ramos
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alaa Altahan
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Taylor Alloway
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael G. Martin
- Department of Hematology and Oncology, The West Cancer Center, Memphis, TN, USA
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Pardal E, Díez Baeza E, Salas Q, García T, Sancho JM, Monzón E, Moraleda JM, Córdoba R, de la Cruz F, Queizán JA, Rodríguez MJ, Navarro B, Hernández JA, Díez R, Vahi M, Viguria MC, Canales M, Peñarrubia MJ, González-López TJ, Montes-Moreno S, González-Barca E, Caballero D, Martín A. A new prognostic model identifies patients aged 80 years and older with diffuse large B-cell lymphoma who may benefit from curative treatment: A multicenter, retrospective analysis by the Spanish GELTAMO group. Am J Hematol 2018; 93:867-873. [PMID: 29658143 DOI: 10.1002/ajh.25107] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/13/2018] [Accepted: 04/04/2018] [Indexed: 12/11/2022]
Abstract
The means of optimally managing very elderly patients with diffuse large B-cell lymphoma (DLBCL) has not been established. We retrospectively analyzed 252 patients aged 80-100 years, diagnosed with DLBCL or grade 3B follicular lymphoma, treated in 19 hospitals from the GELTAMO group. Primary objective was to analyze the influence of the type of treatment and comorbidity scales on progression-free survival (PFS) and overall survival (OS). One hundred sixty-three patients (63%) were treated with chemotherapy that included anthracyclines and/or rituximab, whereas 15% received no chemotherapeutic treatment. With a median follow-up of 44 months, median PFS and OS were 9.5 and 12.5 months, respectively. In an analysis restricted to the 205 patients treated with any kind of chemotherapy, comorbidity scales did not influence the choice of treatment type significantly. Independent factors associated with better PFS and OS were: age < 86 years, cumulative illness rating scale (CIRS) score < 6, intermediate risk (1-2) R-IPI, and treatment with R-CHOP at full or reduced doses. We developed a prognostic model based on the multivariate analysis of the 108 patients treated with R-CHOP-like: median OS was 45 vs. 12 months (P = .001), respectively, for patients with 0-1 vs. 2-3 risk factors (age > 85 years, R-IPI 3-5 or CIRS > 5). In conclusion, treatment with R-CHOP-like is associated with good survival in a significant proportion of patients. We have developed a simple prognostic model that may aid the selection patients who could benefit from a curative treatment, although it needs to be validated in larger series.
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Affiliation(s)
- Emilia Pardal
- Hematology Department; Hospital Virgen del Puerto; Plasencia
| | - Eva Díez Baeza
- Hematology Department; Hospital Universitario de Salamanca- IBSAL, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC); Salamanca
| | - Queralt Salas
- Hematology Department; ICO, Hospital Duran i Reynals; L'Hospitalet de Llobregat
| | - Tomás García
- Hematology Department; Hospital Arnau de Vilanova; Lleida
| | - Juan M. Sancho
- Hematology Department; ICO-IJC-Hospital Germans Trias i Pujol; Badalona
| | - Encarna Monzón
- Hematology Department; Hospital Arnau de Vilanova; Valencia
| | - José M. Moraleda
- Hematology Department; Hospital Universitario Virgen de La Arrixaca, University of Murcia; Murcia
| | - Raúl Córdoba
- Hematology Department; Fundación Jiménez Díaz; Madrid
| | - Fátima de la Cruz
- Hematology Department; Hospital Universitario Virgen del Rocío, IBIS/CSIC/Universidad de Sevilla; Seville
| | | | | | - Belén Navarro
- Hematology Department; Hospital Universitario Puerta de Hierro; Madrid
| | - José A. Hernández
- Hematology Department; Hospital Universitario Infanta Leonor, Universidad Complutense; Madrid
| | - Rosana Díez
- Hematology Department; Hospital de Txagorritxu; Vitoria
| | - María Vahi
- Hematology Department; Hospital Nuestra Señora de Valme; Sevilla
| | | | | | | | | | - Santiago Montes-Moreno
- Department of Pathology / Laboratorio de Hematopatología Traslacional; IDIVAL, Hospital Universitario Marqués de Valdecilla; Santander
| | - Eva González-Barca
- Hematology Department; ICO, Hospital Duran i Reynals; L'Hospitalet de Llobregat
| | - Dolores Caballero
- Hematology Department; Hospital Universitario de Salamanca- IBSAL, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC); Salamanca
| | - Alejandro Martín
- Hematology Department; Hospital Universitario de Salamanca- IBSAL, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC); Salamanca
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Gemcitabine-oxaliplatin plus rituximab (R-GemOx) as first-line treatment in elderly patients with diffuse large B-cell lymphoma: a single-arm, open-label, phase 2 trial. LANCET HAEMATOLOGY 2018; 5:e261-e269. [DOI: 10.1016/s2352-3026(18)30054-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022]
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Prognostic Significance of Blood Transfusion in Elderly Patients with Primary Diffuse Large B-Cell Lymphoma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6742646. [PMID: 29750167 PMCID: PMC5884326 DOI: 10.1155/2018/6742646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/07/2018] [Accepted: 02/18/2018] [Indexed: 01/02/2023]
Abstract
The current study sought to evaluate whether blood transfusions affect survival of elderly patients with primary diffuse large B-cell lymphoma (DLBCL). A total of 104 patients aged 60 years and over were enrolled and divided into two groups: 24 patients who received transfusions and 80 patients who did not. Statistical analyses showed significant differences in LDH levels, platelet (Plt) counts, and hemoglobin (Hb) and albumin (Alb) levels between the two groups. Univariate analyses showed that LDH level ≥ 245 IU/L, cell of origin (germinal center/nongerminal center), and blood transfusion were associated with both overall survival (OS) and progression-free survival (PFS). Higher IPI (3–5), Alb level < 35 g/L, and rituximab usage were associated with OS. Appearance of B symptoms was associated with PFS. Multivariate analyses showed that cell of origin and rituximab usage were independent factors for OS and LDH level was an independent factor for PFS. Blood transfusion was an independent factor for PFS, but not for OS. Our preliminary results suggested that elderly patients with primary DLBCL may benefit from a restrictive blood transfusion strategy.
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Chemotherapy is administered to a minority of hospitalized patients with diffuse large B-cell lymphoma and is associated with less likelihood of death during hospitalization. Cancer Epidemiol 2018; 53:137-140. [PMID: 29438924 DOI: 10.1016/j.canep.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/30/2017] [Accepted: 01/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND While treatment of DLBCL is largely outpatient, some patients require planned or unplanned admissions for chemotherapy, new diagnosis, relapse, or toxicity. We examined risk factors for receipt of inpatient chemotherapy and death during hospitalization. METHODS We analyzed data from the 2012-2013 HCUP-NIS. We identified patient and hospital characteristics that were associated with chemotherapy administration and death. RESULTS Chemotherapy was given in 3260/11,150 (29.2%) of hospitalizations. Younger age, urban teaching hospitals, fewer chronic conditions, male sex, non-Medicare insurance, and "less likelihood of dying" were associated with chemotherapy. Chemotherapy portended lower odds of death; older age and longer hospitalizations were associated with increased odds of death. CONCLUSION We identified socio-demographics and clinical characteristics associated with inpatient chemotherapy in DLBCL patients. Chemotherapy is associated with lower odds of death during hospitalization, suggesting that most chemotherapy is given appropriately to non-critically ill patients. Clinical acuity is a stronger predictor of death than socio-demographics.
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Is it possible to improve prognostic value of NCCN-IPI in patients with diffuse large B cell lymphoma? The prognostic significance of comorbidities. Ann Hematol 2017; 97:267-276. [PMID: 29130134 DOI: 10.1007/s00277-017-3170-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022]
Abstract
The prognostic value of the International Prognostic Index (IPI) has been re-evaluated in the rituximab-treated diffuse large B cell lymphoma (DLBCL) patients. Accordingly, National Comprehensive Cancer Network-IPI (NCCN-IPI) has been introduced to estimate prognosis of DLBCL patients. However, comorbidities that frequently affect elderly DLBCL patients were not analyzed. The aim of this study was to evaluate the prognostic significance of comorbidities using Charlson Comorbidity Index (CCI) in 962 DLBCL patients. According to CCI, majority of patients (73.6%) did not have any comorbidity, while high CCI (≥ 2) was observed in 71/962 (7.4%) patients, and in 55/426 (12.9%) of the elderly patients aged ≥ 60 years. When the CCI was analyzed in a multivariate model along with the NCCN-IPI parameters, it stood out as a threefold independent risk factor of a lethal outcome. Also, we have developed a novel comorbidity-NCCN-IPI (cNCCN-IPI) by adding additional 3 points if the patient had a CCI ≥ 2. Four risk groups emerged with the following patient distribution in low, low-intermediate, high-intermediate, and high group: 3.4, 34.3, 49.4, and 12.5%, respectively. The prognostic value of the new cNCCN-IPI was 2.1% improved compared to that of the IPI, and 1.3% improved compared to that of the NCCN-IPI (p < 0.05). This difference was more pronounced in elderly patients, in whom the cNCCN-IPI showed a 5.1% better discriminative power compared to that of the IPI, and 3.6% better compared to the NCCN-IPI. The NCCN-IPI enhanced by the CCI and combined with redistributed risk groups is better for differentiating risk categories in unselected DLBCL patients, especially in the elderly.
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