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Carras S, Torroja A, Emadali A, Montaut E, Daguindau N, Tempescul A, Moreau A, Tchernonog E, Schmitt A, Houot R, Dartigeas C, Barbieux S, Corm S, Banos A, Fouillet L, Dupuis J, Macro M, Fleury J, Jardin F, Sarkozy C, Damaj G, Feugier P, Fornecker LM, Chabrot C, Dorvaux V, Bouabdallah K, Amorim S, Garidi R, Voillat L, Joly B, Morineau N, Moles MP, Zerazhi H, Fontan J, Arkam Y, Alexis M, Delwail V, Vilque JP, Ysebaert L, Burroni B, Callanan M, Le Gouill S, Gressin R. Long-term analysis of the RiBVD phase II trial reveals the unfavorable impact of TP53 mutations and hypoalbuminemia in older adults with mantle cell lymphoma; for the LYSA group. Haematologica 2024; 109:1857-1865. [PMID: 38031755 PMCID: PMC11141646 DOI: 10.3324/haematol.2023.283724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
Between 2011 and 2012, a phase II trial evaluated the use of the RiBVD (rituximab, bendamustine, velcade and dexamethasone) combination as first-line treatment for mantle cell lymphoma (MCL) patients over the age of 65. We have now re-examined the classic prognostic factors, adding an assessment of TP53 mutation status. Patients (N=74; median age 73 years) were treated with the RiBVD combination. Median progression-free survival (mPFS) was 79 months and median overall survival (mOS) was 111 months. TP53 mutation status was available for 54/74 (73%) patients. TP53 mutations (TP53mt) were found in 12 patients (22.2%). In multivariate analysis, among the prognostic factors (PF) evaluated, only TP53mt and an albumin level (Alb) 3.6 g/dL were independently associated with a shorter mPFS. A hazard ratio (HR) of 3.16 (1.3-9.9, P=0.014) was obtained for TP53mt versus TP53 wild-type (wt), and 3.6 (1.39-9.5, P=0.009) for Alb <3.6 g/dL versus Alb ≥3.6 g/dL. In terms of mOS, multivariate analysis identified three PF: TP53mt (HR: 5.9 [1.77-19.5, P=0.004]), Alb <3.6 g/dL (HR: 5.2 [1.46- 18.5, P=0.011]), and ECOG=2 (HR: 3.7 [1.31-10.6, P=0.014]). Finally, a score combining TP53 status and Alb distinguished three populations based on the presence of 0, 1, or 2 PF. For these populations, mPFS was 7.8 years, 28 months, and 2.5 months, respectively. Our prolonged follow-up confirmed the efficacy of the RiBVD regimen, comparing it favorably to other regimens. TP53mt and hypoalbuminemia emerge as strong PF that can be easily integrated into prognostic scores for older adult patients with MCL.
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Affiliation(s)
- Sylvain Carras
- Université Grenoble Alpes, University Hospital, Institute For Advanced Biosciences (INSERM U1209, CNRSéUMR 5309, UGA), Molecular Biology Department, Grenoble
- Université Grenoble Alpes, University Hospital, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology Department, Grenoble
| | - Alexia Torroja
- Université Grenoble Alpes, University Hospital, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology Department, Grenoble
| | - Anouk Emadali
- Université Grenoble Alpes, University Hospital, Institute for Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Research & Innovation Unit, Grenoble
| | - Emilie Montaut
- Université Grenoble Alpes, University Hospital, Institute for Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Research & Innovation Unit, Grenoble
| | | | | | - Anne Moreau
- Pathology Department, University Hospital, Nantes
| | | | - Anna Schmitt
- Hematology Department, Cancerology Institute Bergonie, Bordeaux
| | - Roch Houot
- Hematology Department, University Hospital, Rennes
| | | | | | - Selim Corm
- Hematology Department, Chambery Hospital, Chambery
| | - Anne Banos
- Hematology Department, Bayonne Cote Basque Hospital, Bayonne
| | | | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil
| | | | - Joel Fleury
- Hematology Department, Cancerology Institute, Clermont-Ferrand
| | | | | | - Ghandi Damaj
- Hematology Department, University Hospital, Caen
| | | | | | - Cecile Chabrot
- Hematology Department, University Hospital, Clermont-Ferrand
| | | | | | - Sandy Amorim
- Hematology & Cellular Therapy Department, Hospital Saint Vincent de Paul, Université Catholique de Lille, Lille
| | - Reda Garidi
- Hematology Department, Hospital Saint Quentin, Saint Quentin
| | - Laurent Voillat
- Hematology Department, Hospital Chalon sur Saone, Chalon sur Saone
| | - Bertrand Joly
- Hematology Department, Corbeil Hospital, Corbeil-Essonnes
| | - Nadine Morineau
- Hematology Department, Hospital La Roche Sur Yon, La Roche Sur Yon
| | | | | | - Jean Fontan
- Hematology Department, University Hospital, Besançon
| | - Yazid Arkam
- Hematology Department, Mulhouse Hospital, Mulhouse
| | - Magda Alexis
- Hematology Department, Orleans Hospital, Orleans
| | - Vincent Delwail
- Onco-Hematology Department, University Hospital Poitiers and INSERM, CIC 1402, University of Poitiers, Poitiers
| | | | - Loic Ysebaert
- Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse
| | - Barbara Burroni
- Assistance Publique – Hôpitaux de Paris (APHP), Hôpital Cochin, Department of Pathology, Centre de Recherche des Cordeliers, Sorbonne University, Inserm, UMRS 1138, Université Paris Cité, F-75006 Paris
| | - Mary Callanan
- Unit For Innovation in Genetics and Epigenetics and Oncology, Dijon University Hospital, Dijon, France
| | - Steven Le Gouill
- Institut Curie, Paris and Paris Saint Quentin University, UVSQ, Paris
| | - Rémy Gressin
- Université Grenoble Alpes, University Hospital, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology Department, Grenoble
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Yhim HY, Park Y, Kim JA, Shin HJ, Do YR, Moon JH, Kim MK, Lee WS, Kim DS, Lee MW, Choi YS, Jeong SH, Kim KH, Kim J, Lee CH, Song GY, Yang DH, Kwak JY. Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort study. Korean J Intern Med 2024; 39:501-512. [PMID: 38287501 PMCID: PMC11076889 DOI: 10.3904/kjim.2023.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND/AIMS Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). METHODS This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). RESULTS The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. CONCLUSION This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.
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Affiliation(s)
- Ho-Young Yhim
- Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
| | - Yong Park
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Jeong-A Kim
- Department of Internal Medicine, The Catholic University of Korea, St. Vincent Hospital, Suwon,
Korea
| | - Ho-Jin Shin
- Department of Internal Medicine, Pusan National University Hospital, Busan,
Korea
| | - Young Rok Do
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu,
Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu,
Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan,
Korea
| | - Dae Sik Kim
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Myung-Won Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Kyoung Ha Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Jinhang Kim
- Department of Internal Medicine, The Catholic University of Korea, St. Vincent Hospital, Suwon,
Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
| | - Ga-Young Song
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Deok-Hwan Yang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jae-Yong Kwak
- Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
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Hormigo-Sanchez AI, Lopez-Garcia A, Mahillo-Fernandez I, Askari E, Morillo D, Perez-Saez MA, Riesco M, Urrutia C, Martinez-Peromingo FJ, Cordoba R, Gonzalez-Montalvo JI. Frailty assessment to individualize treatment in older patients with lymphoma. Eur Geriatr Med 2023; 14:1393-1402. [PMID: 37823983 PMCID: PMC10754742 DOI: 10.1007/s41999-023-00870-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE A study analyzing the application of a protocol of comprehensive geriatric assessment (CGA) in older patients with lymphoma was carried out to allow frailty-based patient classification and individualized treatment. METHODS Lymphoma patients older than 70 years referred to the Geriatric Clinic at a tertiary hospital between May 2016 and March 2021 were included. The assessment protocol included comorbidity, polypharmacy, nutritional, functional, and mental status, geriatric syndromes, and life expectancy. CGA enabled patient classification into four groups (Type I to Type IV) based on frailty assessment instrument scoring and clinical, functional, and mental status. Variables were compared using parametric and non-parametric statistical tests and Kaplan-Meier survival curves. RESULTS Ninety-three patients (55.9% women) were included. Median age was 81.1 years (± 5.7). 23 patients (24.7%) were classified as robust (type I), 30 (32.3%) as pre-frail (type II) with potentially reversable deficits, 38 (40.9%) as frail (type III), and 2 (2.2%) as requiring palliative care (type IV). Patients received oncospecific treatment with modifications carried out in 64.5% of cases based on CGA results. Differences in overall survival (p = 0.002), response to treatment (p < 0.001) and likelihood of increased frailty (p = 0.024) were observed, with type III-IV patients showing significantly worse outcomes. CONCLUSION Performance of standardized, systematic CGA by geriatricians permits older lymphoma patients to be classified according to frailty, with significant differences in terms of clinical outcomes across groups. We propose incorporating CGA performed by geriatricians as part of the multidisciplinary care team to optimize therapeutic strategy for these patients.
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Affiliation(s)
- Ana I Hormigo-Sanchez
- Department of Geriatric Medicine, Fundación Jiménez Díaz University Hospital, Avenida Reyes Católicos, 2. CP 28040, Madrid, Spain.
- Health Research Institute IIS-FJD, Madrid, Spain.
- Faculty of Medicine, Department of Medicine, Autonoma University of Madrid, Madrid, Spain.
| | - Alberto Lopez-Garcia
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
- Health Research Institute IIS-FJD, Madrid, Spain
| | | | - Elham Askari
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
| | - Daniel Morillo
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
| | - María A Perez-Saez
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
| | - Miriam Riesco
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | - Celia Urrutia
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | | | - Raúl Cordoba
- Department of Hematology, Fundación Jiménez, Diaz University Hospital, Madrid, Spain
- Oncohealth Institute, Fundación Jiménez Diaz University Hospital, Madrid, Spain
- Health Research Institute IIS-FJD, Madrid, Spain
| | - Juan I Gonzalez-Montalvo
- Department of Geriatric Medicine, La Paz University Hospital, Madrid, Spain
- Faculty of Medicine, Department of Medicine, Autonoma University of Madrid, Madrid, Spain
- Biomedical Research Institute of La Paz University Hospital. IdiPAZ, Madrid, Spain
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Feng R, Zhang S, Li JT, Wang T, Zhang CL, Bai JF, Yang L, Wang LR, Jing HM, Liu H. Low-dose decitabine for previously untreated acute myeloid leukemia ineligible for intensive chemotherapy aged 65 years or older: a prospective study based on comprehensive geriatric assessment. Ther Adv Hematol 2023; 14:20406207231208979. [PMID: 38033755 PMCID: PMC10685783 DOI: 10.1177/20406207231208979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/29/2023] [Indexed: 12/02/2023] Open
Abstract
Background The outcome of patients with acute myeloid leukemia (AML) aged ⩾65 years is poor. Effective treatment options are limited for patients with AML who cannot tolerate intensive chemotherapy. Objectives We aimed to evaluate the efficacy of low-dose decitabine in previously untreated patients with AML aged ⩾65 years who were ineligible for intensive chemotherapy based on a comprehensive geriatric assessment. Design We performed a prospective, multicenter, open-label, and non-randomized study. Methods Patients were enrolled at four centers in Beijing between 1 January 2017 and 31 December 2020. They were treated with decitabine at a dose of 6 mg/m2 for 10 days. The treatment was repeated every 28 days for one cycle for a total of six cycles. The primary endpoint of our study was overall survival (OS) at the end of the first year after enrolment. The secondary endpoints included overall response rate, leukemia-free survival, relapse rate, treatment-related mortality (TRM), quality of life, safety, and transfusion dependence. Patients were continuously monitored for toxicity. Results Overall, 47 patients (30 males and 17 females) participated in this study. The median age of the enrolled patients was 78 (range, 65-90) years. The median follow-up time was 22.2 (range, 4.6-38.8) months. Fifteen (31.9%) patients achieved complete remission (CR), 11 (23.4%) patients achieved partial remission, 3 (6.4%) patients achieved hematological improvement only, and 18 (38.3%) patients did not achieve remission. The median time to obtain CR was 2 months. The median CR was 8.5 months. Of the patients, 36 (76.6%) patients completed six cycles of treatment with low-dose decitabine, and the 1-year OS was 36.1%. According to instrumental activities of daily living scales, age, comorbidities, and albumin (IACA) scores, the median survival was 11.2 months in the unfit group and 6 months in the frail group. The 1-year OS rates in the unfit and frail groups were 49.2% and 23.4%, respectively. Grade ⩾3 non-hematological toxicity was observed in 70.2% (33/47) of the patients. TRM occurred in three patients. No early deaths occurred after treatment. Conclusion In newly diagnosed older patients with AML whose IACA assessment was unfit or frail for standard chemotherapy, treatment with low-dose decitabine demonstrated clinical activity and good security in our study.
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Affiliation(s)
- Ru Feng
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Shuai Zhang
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Jiang-Tao Li
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Ting Wang
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Chun-Li Zhang
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Jie-Fei Bai
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China
| | - Lei Yang
- Department of Hematology, Beijing Tongren Hospital, Beijing, China
| | - Li-Ru Wang
- Department of Hematology, Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Hong-Mei Jing
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Hui Liu
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R. China No. 1 DaHua Road, Dong Dan, Beijing 100730, China
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5
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Gradel KO. Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review. J Clin Med 2023; 12:6132. [PMID: 37834777 PMCID: PMC10573484 DOI: 10.3390/jcm12196132] [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: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark; ; Tel.: +45-21-15-80-85
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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6
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Gradel KO, Larsen TS, Frederiksen H, Vinholt PJ, Iachina M, Póvoa P, Zampieri FG, Nielsen SL, Dessau RB, Møller JK, Jensen TG, Chen M, Coia JE, Jelicic J. Impact of C-reactive protein and albumin levels on short, medium, and long term mortality in patients with diffuse large B-cell lymphoma. Ann Med 2022; 54:713-722. [PMID: 35238275 PMCID: PMC8896183 DOI: 10.1080/07853890.2022.2046287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives and study design: In this population-based study of 602 patients, we amended C-reactive protein (CRP) and plasma albumin (PA) levels around the diagnosis of diffuse large B-cell lymphoma (DLBCL) to the International Prognostic Index (IPI) and assessed 0-90, 91-365, and +365-day survival.Results: The CRP did not contribute to the IPI's prognostic or discriminatory ability, regardless of time period, particularly not in models with PA. In contrast, the PA was an important contributor, especially in the 0-90 day period, but also up to one year after the diagnosis. For day 0-90, the model with the IPI only had an Area Under the Receiver Operating Characteristics (AUROC) of 0.742, whereas the IPI with PA as a continuous variable rendered an AUROC of 0.841. Especially the lower PA quartile (18-32 g/L) contributed to the worse prognosis.Conclusions: The amendment of PA to the IPI may significantly improve the short-term prognostic and discriminative ability.Key messagesThe amendment of the plasma albumin (PA) level to the International Prognostic Index significantly improved the prediction of mortality up to one year after the diagnosis of diffuse large B-cell lymphoma.It was especially the lower quartile of the PA level (18-32 g/L) that contributed to the worse prognosis.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,OPEN - Odense Patient Data Exploratory Network, Odense University Hospital, Odense C, Denmark
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Maria Iachina
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Pedro Póvoa
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,The Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, Lisbon, and NOVA Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal
| | - Fernando Godinho Zampieri
- Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Research Institute, dHCor-Hospital Do Coração, São Paulo, Brazil
| | - Stig Lønberg Nielsen
- Department of Infectious Diseases, Odense University Hospital, and Research Unit of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital, and Department of Clinical Research, Research Unit of Clinical Microbiology, University of Southern Denmark, Odense C, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Jelena Jelicic
- Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review. Biomedicines 2022; 10:biomedicines10112917. [PMID: 36428485 PMCID: PMC9687245 DOI: 10.3390/biomedicines10112917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/02/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient's fitness and decide whether to pursue a curative or palliative approach. The ABVD regimen is poorly tolerated in unfit patients, with high treatment-related mortality. Alternative chemotherapy approaches have been explored, with mixed results obtained concerning their feasibility and toxicity in phase II trials. The introduction of brentuximab vedotin-based regimens led to a paradigm shift in first- and further-line treatment of elderly Hodgkin lymphoma patients, providing adequate disease control within a broader patient population. As far as checkpoint inhibitors are concerned, we are only just beginning to understand the role in the treatment of this population. In relapsed/refractory settings there are few options, ranging from autologous stem cell transplantation in selected patients to pembrolizumab, but unfortunately, palliative care is the most common modality. Importantly, published studies are frequently burdened with numerous biases (such as low numbers of patients, selection bias and lack of geriatric assessment), leading to low level of evidence. Furthermore, there are few ongoing studies on this topic. Thus, elderly Hodgkin lymphoma patients are hard to treat and represent an unmet need in hematologic oncology. In conclusion, treatment needs to be personalized and tailored on a case-by-case basis. In this article, we outline treatment options for elderly Hodgkin lymphoma patients.
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Akhtar OS, Huang LW, Tsang M, Torka P, Loh KP, Morrison VA, Cordoba R. Geriatric assessment in older adults with Non-Hodgkin lymphoma: A Young International Society of Geriatric Oncology (YSIOG) review paper. J Geriatr Oncol 2022; 13:572-581. [PMID: 35216939 DOI: 10.1016/j.jgo.2022.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a disease of older adults, with a median age at diagnosis of 67 years. Treatment in older adults with NHL is challenging. The aging process is associated with a decline in functional reserve that varies among individuals, and results in an increasing risk of treatment-related toxicity and mortality. Chronological age and performance status fail to capture the multidimensional and heterogeneous nature of the aging process. A geriatric assessment (GA) screens multiple geriatric domains and provides a more accurate assessment of functional reserve. Several abbreviated GA tools have been developed for use in oncology clinics and help identify patients at high risk for chemotherapy-related toxicity and mortality. In this review, we explore GA tools validated for use in patients with NHL. We discuss the evidence behind GA-guided treatment in NHL and present a suggested approach to assessing frailty in this patient population.
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Affiliation(s)
| | - Li-Wen Huang
- San Francisco VA Medical Center, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mazie Tsang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Vicki A Morrison
- Hennepin Healthcare/University of Minnesota, Minneapolis, MN, USA
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
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9
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Aussedat G, Maucort-Boulch D, Rey P, Safar V, Karlin L, Elsensohn MH, Bachy E, Lebras L, Favier B, Vantard N, Ghergus D, Golfier C, Sesques P, Lazareth A, Lequeu H, Ferrant E, Salles G, Nicolas-Virelizier E, Ghesquieres H. Rituximab in combination with adapted-dose of ifosfamide and etoposide as salvage treatment in elderly refractory/relapsed diffuse large B-cell lymphoma patients non-candidate for high dose therapy: a retrospective study. Leuk Lymphoma 2021; 63:599-607. [PMID: 34720034 DOI: 10.1080/10428194.2021.1998483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We retrospectively reviewed for 72 relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) patients ineligible for autologous stem-cell transplantation (ASCT) treated between 2004 and 2017, efficacy and safety profile of rituximab (375 mg/m2) in combination with etoposide (300 mg/m2) and ifosfamide (1500 mg/m2) at 2, 3, or 4-week intervals. Median age was 79 years (range, 64-92). The median number of previous line was 1 (range 1-8). Patients received a median of six cycles (1-12). Fourteen patients (19%) presented partial and 14 complete responses (19%). Among the 369 cycles, nine patients developed febrile neutropenia (13%), 14 a grade 3-4 neutropenia (19%), 7 a grade 3-4 thrombocytopenia (10%) without grade 3-4 non-hematological toxicity. With a median follow up of 7.8 months, the median progression-free survival, overall survival, and duration of response were 4.4 months, 9.4 months, and 12 months, respectively. This regimen represents a therapeutic option in R/R DLBCL patients ineligible to ASCT.
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Affiliation(s)
- Guillaume Aussedat
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Delphine Maucort-Boulch
- Department of Statistics and Bioinformatics, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Philippe Rey
- Department of Hematology, Cancer Léon Bérard, Université Claude Bernard Lyon 1, Lyon, France
| | - Violaine Safar
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Lionel Karlin
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Mad Helenie Elsensohn
- Department of Statistics and Bioinformatics, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Emmanuel Bachy
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laure Lebras
- Department of Hematology, Cancer Léon Bérard, Université Claude Bernard Lyon 1, Lyon, France
| | - Bertrand Favier
- Department of Pharmacy, Centre Léon-Bérard, Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolas Vantard
- Department of Clinical Oncology Pharmacy, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Dana Ghergus
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Camille Golfier
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pierre Sesques
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Lazareth
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Hélène Lequeu
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Emmanuelle Ferrant
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Gilles Salles
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Hervé Ghesquieres
- Department of Hematology, Hôpital Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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10
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Scharf A, Voigt L, Vardhana S, Matsoukas K, Wall LM, Arevalo M, Diamond LC. What Should Clinicians Do When a Patient's Autonomy Undermines Her Being Treated Equitably? AMA J Ethics 2021; 23:E97-108. [PMID: 33635189 PMCID: PMC8366686 DOI: 10.1001/amajethics.2021.97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Language and cultural barriers can impede communication between patients and clinicians, exacerbating health inequity. Additional complications can arise when family members, intending to protect their loved ones, ask clinicians to lie or not disclose to patients their diagnoses, prognoses, or intervention options. Clinicians must express respect for patients' and families' cultural, religious, and social norms regarding health care decision making, but they might also be ethically troubled by some decisions' effects on patients' health outcomes. This article suggests strategies for clinicians trying to overcome linguistic and cultural barriers to equitable patient care.
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Affiliation(s)
- Amy Scharf
- Member of the ethics committee at Memorial Sloan Kettering Cancer Center in New York City
| | - Louis Voigt
- Associate professor of clinical medicine and anesthesiology at Weill Cornell Medical College in New York City
| | - Santosha Vardhana
- Medical oncologist at Memorial Sloan Kettering Cancer Center in New York City
| | - Konstantina Matsoukas
- Research informationist at the Memorial Sloan Kettering Cancer Center's Medical Library in New York City
| | - Lisa M Wall
- Clinical nurse specialist and ethics consultant at Memorial Sloan Kettering Cancer Center in New York City
| | - Maria Arevalo
- Clinical nurse at Memorial Sloan Kettering Cancer Center in New York City
| | - Lisa C Diamond
- Member of the research faculty of the Memorial Sloan Kettering Cancer Center Immigrant Health and Cancer Disparities Service
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11
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Dai S, Ye Y, Kong X, Li J, Ding K. A predictive model for early recurrence of colorectal-cancer liver metastases based on clinical parameters. Gastroenterol Rep (Oxf) 2021; 9:241-251. [PMID: 34316374 PMCID: PMC8309687 DOI: 10.1093/gastro/goaa092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022] Open
Abstract
Background The prognosis for patients with colorectal-cancer liver metastases (CRLM) after curative surgery remains poor and shows great heterogeneity. Early recurrence, defined as tumor recurrence within 6 months of curative surgery, is associated with poor survival, requiring earlier detection and intervention. This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies. Material and methods A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training (n = 150) and validation (n = 52) sets. Baseline information and radiological, pathological, and laboratory findings were extracted from medical records. Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram, which was validated for discrimination, calibration, and clinical application. Results Liver-metastases number, lymph-node suspicion, neurovascular invasion, colon/rectum location, albumin and post-operative carcinoembryonic antigen, and carbohydrate antigen 19–9 levels (CA19–9) were independent predictive factors and were used to construct the nomogram for early recurrence after curative surgery. The area under the curve was 0.866 and 0.792 for internal and external validation, respectively. The model significantly outperformed the clinical risk score and Beppu’s model in our data set. In the lift curve, the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30% high-risk patients. Conclusion Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.
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Affiliation(s)
- Siqi Dai
- Department of Colorectal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
| | - Yao Ye
- Department of Colorectal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
| | - Xiangxing Kong
- Department of Colorectal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
| | - Jun Li
- Department of Colorectal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
| | - Kefeng Ding
- Department of Colorectal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
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12
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Di M, Huntington SF, Olszewski AJ. Challenges and Opportunities in the Management of Diffuse Large B-Cell Lymphoma in Older Patients. Oncologist 2020; 26:120-132. [PMID: 33230948 DOI: 10.1002/onco.13610] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Most patients with diffuse large B-cell lymphoma (DLBCL) are diagnosed at age 60 years or older. Challenges to effective therapy among older individuals include unfavorable biologic features of DLBCL, geriatric vulnerabilities, suboptimal treatment selection, and toxicities of cytotoxic chemotherapy. Wider application of geriatric assessments may help identify fit older patients who benefit from standard immunochemotherapy without unnecessary dose reductions. Conversely, attenuated regimens may provide a better balance of risk and benefit for selected unfit or frail patients. Supportive care with the use of corticosteroid-based prephase, prophylactic growth factors, and early institution of supportive and palliative care can help maximize treatment tolerance. Several novel or emerging therapies have demonstrated favorable toxicity profiles, thus facilitating effective treatment for elderly patients. In the relapsed or refractory setting, patients who are not candidates for stem cell transplantation can benefit from newly approved options including polatuzumab vedotin-based combinations or tafasitamab plus lenalidomide, which may have higher efficacy and/or lower toxicity than historical chemotherapy regimens. Chimeric antigen receptor T-cell therapy has been successfully applied to older patients outside of clinical trials. In the first-line setting, emerging immunotherapy options (bispecific antibodies) and targeted therapies (anti-CD20 antibodies combined with lenalidomide and/or B-cell receptor inhibitors) may provide chemotherapy-free approaches for DLBCL. Enrolling older patients in clinical trials will be paramount to fully examine potential efficacy and toxicity of these strategies. In this review, we discuss recent advances in fitness stratification and therapy that have expanded curative options for older patients, as well as future opportunities to improve outcomes in this population. IMPLICATIONS FOR PRACTICE: Management of diffuse large B-cell lymphoma in older patients poses challenges due to aggressive disease biology and geriatric vulnerability. Although R-CHOP remains standard first-line treatment, geriatric assessment may help evaluate patients' fitness for immunochemotherapy. Corticosteroid prephase, prophylactic growth factors, and early palliative care can improve tolerance of treatment. Novel salvage options (polatuzumab vedotin-based combinations, tafasitamab plus lenalidomide) or chimeric antigen receptor T-cell therapy should be considered in the relapsed or refractory setting for patients ineligible for stem cell transplantation. Emerging immunotherapies (bispecific antibodies) and targeted therapies provide potential first-line chemotherapy-free approaches, which need to be rigorously assessed in clinical trials that involve geriatric patients.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott F Huntington
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Olszewski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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13
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A new tool for comprehensive geriatric assessment in elderly patients with acute myeloid leukemia: a pilot study from China. Chin Med J (Engl) 2020; 133:381-387. [PMID: 31934939 PMCID: PMC7046252 DOI: 10.1097/cm9.0000000000000645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a common type of hematological malignancy in elderly people. Geriatricians have developed comprehensive geriatric assessment (CGA) methods for elderly patients; however, the tools used for CGA in AML are not uniform. Thus, we aimed to validate the instrumental activities of daily living (IADL) scales, age, comorbidities (Charlson Comorbidity Index), and albumin (IACA) index, which is a new tool for CGA, in elderly patients with AML. METHODS Patients aged ≥60 years who had been diagnosed with AML were screened for eligibility. Among the IACA low-, intermediate-, and high-risk groups, continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using χ and Fisher exact tests. In addition, probabilities of overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS A total of 21, 34, and 6 patients were categorized into IACA low-risk (0 point), intermediate-risk (1-2 points), and high-risk (≥3 points) groups, respectively. The rates of relapse/progression-related mortality were 23.8%, 58.8%, and 100.0% in the IACA low-, intermediate-, and high-risk groups, respectively (χ = 12.81, P < 0.001). The 2-year probabilities of OS were 47.7% (95% confidence interval [CI] 22.8%-72.6%) and 20.2% (95% CI 5.9%-34.5%) in the IACA low- and intermediate-risk groups, respectively (χ = 5.99, P = 0.014), which were significantly higher than those in the high-risk group (low-risk [47.7% (95% CI 22.8%-72.6%)] vs. high-risk [0], χ = 20.80, P < 0.001; intermediate-risk [20.2% (95% CI 5.9%-34.5%)] vs. high-risk [0], χ = 7.56, P = 0.006; respectively). In the IACA low-risk group, the 2-year probability of OS in patients receiving induction chemotherapy (50.8% [95% CI 24.1%-77.5%]) was significantly higher than that in those receiving best supportive care (0, χ = 25.74, P < 0.001). CONCLUSION We suggest that the IACA index might be a simple and effective tool for comprehensive geriatric assessment in elderly AML patients.
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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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Kocher F, Mian M, Seeber A, Fiegl M, Stauder R. 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:E1005. [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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Affiliation(s)
- Florian Kocher
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, 6020 Innsbruck, Austria; (F.K.); (A.S.); (M.F.)
| | - Michael Mian
- Department of Hematology & CBMT, Central Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano-Bozen, Italy;
- Riga Stradiņš University, 1007 Riga, Latvia
| | - Andreas Seeber
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, 6020 Innsbruck, Austria; (F.K.); (A.S.); (M.F.)
| | - Michael Fiegl
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, 6020 Innsbruck, Austria; (F.K.); (A.S.); (M.F.)
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, 6020 Innsbruck, Austria; (F.K.); (A.S.); (M.F.)
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16
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Klepin HD. Ready for prime time: role for geriatric assessment to improve quality of care in hematology practice. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:53-58. [PMID: 31808878 PMCID: PMC6913467 DOI: 10.1182/hematology.2019001299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Older adults represent the growing majority of patients diagnosed with hematologic disorders, yet they remain underrepresented on clinical trials. Older patients of the same chronologic age differ from one another with varying comorbidity and functional reserve. The concepts of frailty and resilience are important to patient-centered care and are patient and setting specific. The use of geriatric assessment to inform tailored decision making and management can personalize care for older adults with hematologic malignancies. This article will highlight available evidence to support the role of geriatric assessment measures to enhance quality of care for older adults diagnosed with hematologic malignancies.
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Affiliation(s)
- Heidi D Klepin
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
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17
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Ready for prime time: role for geriatric assessment to improve quality of care in hematology practice. Blood 2019; 134:2005-2012. [DOI: 10.1182/blood.2019001299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/24/2019] [Indexed: 12/13/2022] Open
Abstract
These 2 reviews respectively examine the value and utility of geriatric assessment (GA) tools and discuss the role of GA in the clinical management of patients with hematologic malignancies.
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18
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Clinical impact of prognostic nutritional index in diffuse large B cell lymphoma. Ann Hematol 2018; 98:401-411. [DOI: 10.1007/s00277-018-3540-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 10/30/2018] [Indexed: 01/07/2023]
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19
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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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