Treatment Individualization in Diffuse Large B-Cell Lymphoma: Is Frailty Enough for Old Adults? An Original Article

Real-world data on the clinical features, therapy patterns, and outcomes of older adults with diffuse large B-cell lymphoma in Latin America: A study from the Grupo de Estudio Latinoamericano de Linfoproliferativos (GELL)

INTRODUCTION

Diffuse large B-cell lymphoma (DLBCL) is the most common type of B-cell lymphoma, predominantly afflicting older adults. There remains a notable absence of data regarding DLBCL in older adults in Latin America.

MATERIALS AND METHODS

We conducted a retrospective analysis of 608 newly diagnosed Latin American patients with DLBCL aged ≥65 years.

RESULTS

The median age at diagnosis was 74 years (range: 65-96 years), 51 % were female, 36 % had an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, and 65 % had advanced disease. The most common regimens used were standard-dose R-CHOP (n = 420, 69 %), R-CVP (n = 77, 12 %), R-mini-CHOP (n = 74, 12 %), and CHOP/CVP (n = 30, 5 %). With a median follow-up of 60 months (95 % confidence interval [CI]: 38.7-75.2 months), the five-year overall survival (OS) rate was 50 % (95 % CI, 43-58). An ECOG PS ≥2 (hazard ratio [HR] 1.93; 95 % CI 1.51-2.46; p < 0.01), advanced clinical stage (HR 1.46; 95 % CI 1.12-1.91; p < 0.01), increased serum lactic dehydrogenase level (HR 1.48; 95 % CI 1.16-1.87; p < 0.01), and albumin level < 3.5 mg/dL (HR 1.64; 95 % CI 1.29-2.10; p < 0.01) were associated with an inferior OS. Using anthracyclines (HR 0.50; 95 % CI 0.38-0.66; p < 0.01) and using rituximab (HR 0.51; 95 % CI 0.36-0.73; p < 0.01) were independently associated with a superior OS.

DISCUSSION

In a large cohort of Latin American older patients with DLBCL, therapy and outcome patterns are similar to those reported internationally. The lack of standardized geriatric assessments in Latin America represents an essential area for research to better stratify older patients with DLBCL deemed to be at higher risk for toxicity.

Validation and modification of simplified Geriatric Assessment and Elderly Prognostic Index: Effective tools for older patients with diffuse large B-cell lymphoma

Geriatric assessment can aid in optimizing treatment strategies and supportive interventions for older patients with diffuse large B-cell lymphoma (DLBCL). Fondazione Italiana Linformi has recently introduced novel geriatric assessment tools, simplified Geriatric Assessment (sGA) and Elderly Prognostic Index (EPI), aimed at tailoring the treatment and predicting the outcomes for older patients with DLBCL. The objectives of this study are the validation and possible modification of the sGA and EPI in China. In the study, both sGA and EPI demonstrated the predictive capabilities for overall survival (OS) and early mortality (both p < 0.05) in older individuals with DLBCL. Albumin, serving as an independent predictive biomarker for OS (p = 0.006), was utilized to adjust the measurements, resulting in the establishment of sGA-A and EPI-A. The sGA-A effectively addressed the shortcomings of the sGA and EPI in predicting PFS and surpassed them in predicting OS and early mortality. Nevertheless, there is insufficient evidence to support the use of sGA and EPI as treatment guidance tools. In conclusion, the modified sGA-A model proved to be a successful instrument for geriatric assessment of older patients with DLBCL.