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Jensen-Battaglia M, LoCastro M, Oh H, Sanapala C, Flannery M, Mendler JH, Liesveld J, Huselton E, Loh KP. Patient-oncologist discussion of treatment decisions: Exploring the role of a patient-centered communication tool for older adults with acute myeloid leukemia and their caregivers. J Geriatr Oncol 2024; 15:101716. [PMID: 38336521 DOI: 10.1016/j.jgo.2024.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Marielle Jensen-Battaglia
- James P. Wilmot Cancer Institute and Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Marissa LoCastro
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Haejung Oh
- The Catholic University of Korea, School of Medicine, Seoul, South Korea
| | | | - Marie Flannery
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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Di M, Keeney T, Belanger E, Huntington SF, Olszewski AJ, Panagiotou OA. Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: A population-based study. J Am Geriatr Soc 2023; 71:2239-2249. [PMID: 36882865 PMCID: PMC10483014 DOI: 10.1111/jgs.18302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To characterize the prevalence of functional and cognitive impairments, and associations between impairments and treatment among older patients with diffuse large B cell lymphoma (DLBCL) receiving nursing home (NH) care. METHODS We used the Surveillance, Epidemiology, and End Results-Medicare database to identify beneficiaries diagnosed with DLBCL 2011-2015 who received care in a NH within -120 ~ +30 days of diagnosis. Multivariable logistic regression was used to compare receipt of chemoimmunotherapy (including multi-agent, anthracycline-containing regimens), 30-day mortality, and hospitalization between NH and community-dwelling patients, estimating odds ratios (OR) and 95% confidence interval (CI). We also examined overall survival (OS). Among NH patients, we examined receipt of chemoimmunotherapy based on functional and cognitive impairment. RESULTS Of the eligible 649 NH patients (median age: 82 years), 45% received chemoimmunotherapy; among the recipients, 47% received multi-agent, anthracycline-containing regimens. Compared with community-dwelling patients, those in a NH were less likely to receive chemoimmunotherapy (OR: 0.34, 95%CI: 0.29-0.41), had higher 30-day mortality (OR: 2.00, 95%CI: 1.43-2.78) and hospitalization (OR: 1.51, 95%CI: 1.18-1.93), and poorer OS (hazard ratio: 1.36, 95%CI: 1.11-1.65). NH patients with severe functional (61%) or any cognitive impairment (48%) were less likely to receive chemoimmunotherapy. CONCLUSIONS High rates of functional and cognitive impairment and low rates of chemoimmunotherapy were observed among NH residents diagnosed with DLBCL. Further research is needed to better understand the potential role of novel and alternative treatment strategies and patient preferences for treatment to optimize clinical care and outcomes in this high-risk population.
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Affiliation(s)
- Mengyang Di
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tamra Keeney
- Center for Aging and Serious Illness, Massachusetts General Hospital, Mongan Institute, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Emmanuelle Belanger
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Scott F. Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Orestis A. Panagiotou
- Department of Services, Policy and Practice, Brown University Health School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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Pénichoux J, Lanic H, Thill C, Ménard AL, Camus V, Stamatoullas A, Lemasle E, Leprêtre S, Lenain P, Contentin N, Kraut-Tauzia J, Fruchart C, Kammoun L, Damaj G, Farge A, Delette C, Modzelewski R, Vaudaux S, Pépin LF, Tilly H, Jardin F. Prognostic relevance of sarcopenia, geriatric, and nutritional assessments in older patients with diffuse large B-cell lymphoma: results of a multicentric prospective cohort study. Ann Hematol 2023; 102:1811-1823. [PMID: 37058153 PMCID: PMC10260702 DOI: 10.1007/s00277-023-05200-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/23/2023] [Indexed: 04/15/2023]
Abstract
This prospective study aimed to investigate the prognostic effect of sarcopenia, geriatric, and nutritional status in older patients with diffuse large B-cell lymphoma (DLBCL). Ninety-five patients with DLBCL older than 70 years who were treated with immunochemotherapy were included. The lumbar L3 skeletal muscle index (L3-SMI) was measured by computed tomography at baseline, and sarcopenia was defined as low L3-SMI. Geriatric assessment included G8 score, CIRS-G scale, Timed Up and Go test, and instrumental activity of daily living. Nutritional status was assessed using the Mini Nutritional Assessment and the body mass index, and several scores used in the literature incorporating nutritional and inflammatory biomarkers, namely the Nutritional and inflammatory status (NIS), Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Glasgow Prognostic Score.Fifty-three patients were considered sarcopenic. Sarcopenic patients displayed higher levels of inflammation markers and lower levels of prealbumin than non-sarcopenic patients. Sarcopenia was associated with NIS, but was not associated with severe adverse events and treatment disruptions. They were, however, more frequent among patients with elevated NIS. Sarcopenia did not appear in this study as a prognostic factor for progression-free survival (PFS) or overall survival (OS). However, NIS emerged as predictive of the outcome with a 2-year PFS rate of 88% in the NIS ≤ 1 group and 49% in the NIS > 1 group and a significant effect in a multivariate analysis for both PFS (p = 0.049) and OS (HR = 9.61, CI 95% = [1.03-89.66], p = 0.04). Sarcopenia was not associated with adverse outcomes, but was related to NIS, which appeared to be an independent prognostic factor.
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Affiliation(s)
- Juliette Pénichoux
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France.
| | - Hélène Lanic
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Caroline Thill
- Department of Statistics, Rouen University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Vincent Camus
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Aspasia Stamatoullas
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Pascal Lenain
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | | | | | - Leila Kammoun
- Department of Oncology-Hematology, Eure-Seine Hospital Center, Evreux, France
| | - Gandhi Damaj
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Agathe Farge
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Caroline Delette
- Department of Clinical Hematology, Amiens University Hospital, Amiens, France
| | | | - Sandrine Vaudaux
- Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | | | - Hervé Tilly
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
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Demirel KD, Özkurt ZN, Doğrul RT, Kaynar LA, Yeğin ZA, Göker B, Yağci M. Is comprehensive geriatric testing guiding in the identification of multiple myeloma patients who are candidates for autologous stem cell transplantation? A prospective analysis. Ann Hematol 2022; 101:2691-2697. [PMID: 36195680 DOI: 10.1007/s00277-022-04992-8] [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: 05/15/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy of older adults. This study aimed to investigate the differences in performance, comorbidity scores, and comprehensive geriatric assessment (CGA) before and after induction therapy in newly diagnosed MM patients, as well as the factors that may be associated with improved performance status after induction therapy. Thirty-seven consecutive patients aged 50 years and older, who were newly diagnosed with MM, were included in the study. The patients underwent performance status evaluation and CGA when first diagnosed and after 4 cycles of induction chemotherapy. The performance status of 11 patients (40.7%) changed after induction therapy. Improvement in performance status was significantly lower in patients who were frail according to the Fried frailty criteria and IMWG scores (60% vs. 25%, p = 0.04), (30.0% vs. 6.2%, p = 0.02), taking more than 2 medications due to comorbidities (p = 0.01, confidence interval 0.06-0.09) and those with renal involvement (80.0% vs. 18.7%, p = 0.002). Those with bone involvement were more prevalent among the patients whose performance status improved (87.5% and 50.0%, p = 0.03). This study demonstrated that performance status might improve after induction therapy. Results suggest that CGA before induction therapy can predict performance status change. These results might have implications for predicting at the time of diagnosis, whether an MM patient can be a transplant candidate after induction therapy.
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Affiliation(s)
- Kübra Durmuş Demirel
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Zübeyde Nur Özkurt
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Rana Tuna Doğrul
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Lale Aydin Kaynar
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Arzu Yeğin
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Münci Yağci
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
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Charlson Comorbidity Index (CCI) in Diffuse Large B-cell Lymphoma: A New Approach in a Multicenter Study. Indian J Hematol Blood Transfus 2022; 39:191-199. [PMID: 36186233 PMCID: PMC9516503 DOI: 10.1007/s12288-022-01567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult lymphomas. The incidence of DLBCL increases with age and has a fairly rapid fatal course without treatment. Patients often have difficulty tolerating standard chemotherapy regimens due to their comorbidities. Charlson Comorbidity Index (CCI), which is calculated by considering 19 different comorbidities, was developed in 1987 and is widely used for mortality prediction in cancer patients. Literature data on CCI and hematological malignancies are limited. Main aim in this study is to evaluate the effectiveness of CCI and compare to the International Prognostic Index (IPI) scoring system in the DLBCL patient group. Methods A total of 170 patients diagnosed with DLBCL between 1.1.2002- 1.12.2020 were included in the study. Statistical analyzes were performed among patients whose IPI and CCI scores were recorded by considering baseline data. Results The median age of patients was 58 (range: 17–84). Thirty-five (20.6%) patients had stage III and 76 (44.7%) had stage IV disease. When the CCI, IPI and ECOG scores were compared with the mortality status of the patients as a reference, AUCs were resulted as 0.628 (95% CI: 0.506–0.749), 0.563 (95% CI: 0.484–0.639) and 0.672 (95% CI: 0.596–0.743), respectively. There was no significant difference between the ROC curves of CCI, IPI and ECOG scores. Patients with a CCI score of ≥ 4 had shorter OS comperad to those with a score of < 4. Conclusion Rather than claiming that CCI is superior to IPI, ECOG or another scoring system in a single-center patient population, it should be stated that CCI is also an effective scoring system in patients diagnosed with DLBCL. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-022-01567-5.
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