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Navarrete-Reyes AP, Mateos-Soria AS, Sánchez-Hernández JJ, Negrete-Najar JP. Frailty and Cancer Prognosis. Curr Oncol Rep 2024:10.1007/s11912-024-01558-x. [PMID: 38865004 DOI: 10.1007/s11912-024-01558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current evidence regarding the prognostic role of frailty in older patients diagnosed with cancer and to explore the evidence regarding its prognostic implications in cancer survivors. RECENT FINDINGS Frailty has been consistently associated with mortality/overall survival, postoperative complications, short- and long-term postoperative mortality, length of stay, among other adverse health-related outcomes in several oncological contexts. The possible association between frailty and treatment toxicity has been less explored, however most studies suggest frailty is a predictor of treatment induced toxicity. In addition, in cancer survivors, frailty is a risk factor for cardiovascular disease, incident type 2 diabetes mellitus, mortality, altered cognitive performance and increased symptom severity. Due to its usefulness in establishing prognosis and informing treatment decision making, it is expected that frailty screening and assessment will continue to gain popularity as part of the pretreatment evaluation of older patients with cancer.
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Affiliation(s)
- Ana Patricia Navarrete-Reyes
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Abigail Samayoa Mateos-Soria
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Internal Medicine Service, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Juan José Sánchez-Hernández
- Geriatric Medicine Department, Geriatric Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Internal Medicine Service, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan Pablo Negrete-Najar
- Geriatric Medicine Service, Hospital General de Zona No. 35, Instituto Mexicano del Seguro Social, Ciudad Juárez, Mexico
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de Pádua Covas Lage LA, De Vita RN, de Oliveira Alves LB, Jacomassi MD, Culler HF, Reichert CO, de Freitas FA, Rocha V, Siqueira SAC, de Oliveira Costa R, Pereira J. Predictors of Survival, Treatment Modalities, and Clinical Outcomes of Diffuse Large B-Cell Lymphoma in Patients Older Than 70 Years Still an Unmet Medical Need in 2024 Based on Real-World Evidence. Cancers (Basel) 2024; 16:1459. [PMID: 38672542 PMCID: PMC11048621 DOI: 10.3390/cancers16081459] [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: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) especially affects the older population. Old (≥60 years) and very old age (≥80 years) DLBCL patients often present high-risk molecular alterations, lower tolerability to conventional immunochemotherapy, and poor clinical outcomes. In this scenario, attenuated therapeutic strategies, such as the R-MiniCHOP and R-MiniCHOP of the elderly regimens, have emerged for this particularly fragile population. However, the responses, clinical outcomes, and toxicities of these regimens currently remain poorly understood, mainly because these individuals are not usually included in controlled clinical trials. METHODS This retrospective, observational, and single-center real-world study included 185 DLBCL, NOS patients older than 70 years treated at the largest oncology center in Latin America from 2009 to 2020. We aimed to assess the outcomes, determine survival predictors, and compare responses and toxicities between three different primary therapeutic strategies, including the conventional R-CHOP regimen and the attenuated R-MiniCHOP and R-MiniCHOP of the elderly protocols. RESULTS The median age at diagnosis was 75 years (70-97 years), and 58.9% were female. Comorbidities were prevalent, including 19.5% with immobility, 28.1% with malnutrition, and 24.8% with polypharmacy. Advanced clinical stage was observed in 72.4%, 48.6% had bulky disease ≥7 cm, 63.2% had B-symptoms, and 67.0% presented intermediate-high/high-risk IPI. With a median follow-up of 6.3 years, the estimated 5-year OS and PFS were 50.2% and 44.6%, respectively. The R-MiniCHOP of the elderly regimen had a lower ORR (p = 0.040); however, patients in this group had higher rates of unfavorable clinical and laboratory findings, including hypoalbuminemia (p = 0.001), IPI ≥ 3 (p = 0.013), and NCCN-IPI ≥ 3 (p = 0.002). Although associated with higher rates of severe neutropenia (p = 0.003), the R-CHOP regimen promoted increased OS (p = 0.003) and PFS (p = 0.005) in comparison to the attenuated protocols. Additionally, age ≥ 75 years, high levels of LDH, B-symptoms, advanced clinical stage (III/IV), neutrophilia, and low lymphocyte/monocyte ratio were identified as poor prognostic factors in this cohort. CONCLUSIONS In this large and real-life Latin American cohort, we demonstrated that patients with DLBCL, NOS older than 70 years still do not have satisfactory clinical outcomes in 2024, with half of cases not reaching 5 years of life expectancy after diagnosis. Although the conventional R-CHOP offers response and survival advantages over attenuated regimens, its myelotoxicity is not negligible. Therefore, the outcomes reported and the prognostic factors here identified may assist clinicians in the appropriate selection of therapeutic strategies adapted to the risk for old and very old DLBCL patients.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Rita Novello De Vita
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Lucas Bassolli de Oliveira Alves
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Mayara D’Auria Jacomassi
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Cadiele Oliana Reichert
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Fábio Alessandro de Freitas
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Fundação Pró-Sangue, Blood Bank of São Paulo, São Paulo 05403000, Brazil
- Department of Hematology & Hemotherapy, Churchill Hospital, Oxford University, Oxford OX3 7LE, UK
| | | | - Renata de Oliveira Costa
- Department of Hematology & Hemotherapy, Faculty of Medicine, Centro Universitário Lusíada (Unilus), Santos 11045101, Brazil;
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
| | - Juliana Pereira
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
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Yun X, Bai J, Feng R, Li J, Wang T, Yang Y, Yin J, Qian L, Zhang S, Cao Q, Xue X, Jing H, Liu H. Validation and modification of simplified Geriatric Assessment and Elderly Prognostic Index: Effective tools for older patients with diffuse large B-cell lymphoma. Cancer Med 2024; 13:e6856. [PMID: 38132832 PMCID: PMC10807600 DOI: 10.1002/cam4.6856] [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: 08/29/2023] [Revised: 11/29/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
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.
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Affiliation(s)
- Xiaoya Yun
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
| | - Jiefei Bai
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Ru Feng
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Jiangtao Li
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Ting Wang
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Yazi Yang
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Jingjing Yin
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Long Qian
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Shuai Zhang
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Qingyun Cao
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Xiaoxuan Xue
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
| | - Hongmei Jing
- Department of Hematology, Lymphoma Research CenterPeking University Third Hospital, Peking UniversityBeijingChina
| | - Hui Liu
- Department of Hematology, Beijing Hospital, National Center of GerontologyInstitute of Geriatric Medicine, Chinese Academy of Medical SciencesBeijingP.R. China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
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4
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Gini G, Tani M, Tucci A, Marcheselli L, Cesaretti M, Bellei M, Pascarella A, Ballerini F, Petrini M, Merli F, Olivieri A, Lanza F, Annibali O, Zilioli VR, Liberati AM, Tisi MC, Arcari A, Marino D, Musuraca G, Pavone V, Fabbri A, Pozzi S, Mannina D, Plenteda C, Celli M, Luminari S. Lenalidomide plus rituximab for the initial treatment of frail older patients with DLBCL: the FIL_ReRi phase 2 study. Blood 2023; 142:1438-1447. [PMID: 37418685 DOI: 10.1182/blood.2022019173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023] Open
Abstract
Treatment of diffuse large B-cell lymphoma (DLBCL) in older patients is challenging, especially for those who are not eligible for anthracycline-containing regimens. Fondazione Italiana Linfomi (FIL) started the FIL_ReRi study, a 2-stage single-arm trial to investigate the activity and safety of the chemo-free combination of rituximab and lenalidomide (R2) in ≥70-year-old untreated frail patients with DLBCL. Frailty was prospectively defined using a simplified geriatric assessment tool. Patients were administered a maximum of 6 28-day cycles of 20 mg oral lenalidomide from days 2 to 22 and IV rituximab 375 mg/m2 on day 1, with response assessment after cycles 4 and 6. Patients with partial response or complete response (CR) at cycle 6 were administered lenalidomide 10 mg/d from days 1 to 21 for every 28 cycles for a total of 12 cycles or until progression or unacceptable toxicity. The primary end point was the overall response rate (ORR) after cycle 6; the coprimary end point was the rate of grade 3 or 4 extrahematological toxicity. The ORR was 50.8%, with 27.7% CR. After a median follow-up of 24 months, the median progression-free survival was 14 months, and the 2-year duration of response was 64%. Thirty-four patients experienced extrahematological toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events grade ≥3. The activity of the R2 combination was observed in a significant proportion of subjects, warranting further exploration of a chemo-free approach in frail older patients with DLBCL. This trial was registered at EudraCT as #2015-003371-29 and clinicaltrials.gov as #NCT02955823.
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Affiliation(s)
- Guido Gini
- Struttura Organizzativa Dipartimentale di Clinica Ematologica, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Monica Tani
- Unità di Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Alessandra Tucci
- Unità di Ematologia, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Luigi Marcheselli
- Uffici Studi Fondazione Italiana Linfomi, sede di Modena, Modena, Italy
| | - Marina Cesaretti
- Uffici Studi Fondazione Italiana Linfomi, sede di Modena, Modena, Italy
| | - Monica Bellei
- Uffici Studi Fondazione Italiana Linfomi, sede di Modena, Modena, Italy
| | - Anna Pascarella
- Unità Operativa Complessa di Ematologia, Ospedale dell'Angelo, Venice-Mestre, Italy
| | - Filippo Ballerini
- Clinica Ematologica, IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy
| | - Mauro Petrini
- Struttura Organizzativa Dipartimentale di Clinica Ematologica, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Merli
- Ematologia, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Attilio Olivieri
- Struttura Organizzativa Dipartimentale di Clinica Ematologica, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Francesco Lanza
- Unità di Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Ombretta Annibali
- Unità di Ematologia e Trapianto di Cellule Staminali, Università Campus Bio-Medico, Rome, Italy
| | - Vittorio Ruggero Zilioli
- Divisione di Ematologia, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Marina Liberati
- Struttura Complessa di Oncoematologia e Autotrapianto, Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy
| | - Maria Chiara Tisi
- Ematologia, Ospedale San Bortolo, Azienda Unità Sanitaria Locale Socio Sanitaria 8 "Berica," Vicenza, Italy
| | - Annalisa Arcari
- Unità di Ematologia, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Dario Marino
- Oncologia 1, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Gerardo Musuraca
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori, Meldola, Italy
| | - Vincenzo Pavone
- Unità Operativa Complessa di Ematologia e Trapianto, Ospedale Pia Fondazione Cardinale Panico, Tricase, Italy
| | - Alberto Fabbri
- Unità di Ematologia, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Samantha Pozzi
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia, Centro Oncologico, Modena, Italy
| | - Donato Mannina
- Dipartimento di Oncoematologia, Ospedale Papardo, Messina, Italy
| | - Caterina Plenteda
- Unità Operativa di Ematologia e Centro Trapianti di Midollo Osseo, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | - Melania Celli
- Unità Operativa di Ematologia, Ospedale degli Infermi, Rimini, Italy
| | - Stefano Luminari
- Ematologia, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
- Dipartimento Chirurgico, Medico, Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico, Oncologico e di Medicina Rigenerativa, Università di Modena e Reggio Emilia, Reggio Emilia, Italy
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Yohannan B, Rios A. Reduced-Intensity Anthracycline-Free Chemoimmunotherapy in Elderly Patients With Newly Diagnosed or Relapsed Diffuse Large B-Cell Lymphoma. J Hematol 2023; 12:176-186. [PMID: 37692866 PMCID: PMC10482608 DOI: 10.14740/jh1144] [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: 05/14/2023] [Accepted: 07/14/2023] [Indexed: 09/12/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL); it has a cure rate of approximately 50% with standard anthracycline-based chemoimmunotherapy. However, the clinical outcomes of elderly unfit/frail DLBCL patients remain suboptimal due to poor tolerance of anthracycline-containing regimens. Herein, we report a series of seven elderly unfit patients with DLBCL who were treated with a reduced-intensity anthracycline-free chemoimmunotherapy (rituximab, cyclophosphamide, vincristine, and prednisone) regimen combined with lenalidomide (R2-COP). Five patients received R2-COP as first-line therapy, and two patients were treated for relapsed DLBCL. Four patients with newly diagnosed DLBCL and two with relapsed disease achieved complete remission. The R2-COP regimen was well tolerated. Interim positron emission tomography (PET) scans in four patients after two to three cycles showed a complete metabolic response. At a median follow-up of 24 months, six patients remain in complete remission. R2-COP is an effective anthracycline-free regimen with encouraging clinical activity in elderly DLBCL patients who are unfit for standard anthracycline-containing regimens.
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Affiliation(s)
- Binoy Yohannan
- Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adan Rios
- Division of Hematology/Oncology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, 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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7
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Cencini E, Tucci A, Puccini B, Cavallo F, Luminari S, Usai SV, Fabbri A, Pennese E, Marino D, Zilioli VR, Balzarotti M, Petrucci L, Tafuri A, Arcari A, Botto B, Zanni M, Hohaus S, Sartori R, Merli M, Gini G, Al Essa W, Musurca G, Tani M, Nassi L, Daffini R, Mammi C, Marcheselli L, Bocchia M, Spina M, Merli F. The elderly prognostic index predicts early mortality in older patients with diffuse large B-cell lymphoma. An ad hoc analysis of the elderly project by the Fondazione Italiana Linfomi. Hematol Oncol 2023; 41:78-87. [PMID: 36177902 DOI: 10.1002/hon.3081] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2022] [Accepted: 09/17/2022] [Indexed: 02/03/2023]
Abstract
The Elderly Prognostic Index (EPI) is based on the integration of a simplified geriatric assessment, hemoglobin levels and International Prognostic Index and has been validated to predict overall survival in older patients with diffuse large B-cell lymphoma (DLBCL). In this study, we evaluated the ability of EPI to predict the risk of early mortality. This study included all patients registered in the Elderly Project for whom treatment details and a minimum follow-up of 3 months were available. Three main treatment groups were identified based on the anthracycline amount administered: cases receiving >70% of the theoretical anthracyclines dose (Full Dose [FD] group), ≤70% (Reduced Dose [RD]) and palliative therapy (PT; no anthracyclines). The primary endpoint was early mortality rate, defined as death for any cause occurring within 90 days from diagnosis. We identified 1150 patients with a median age of 76 years (range 65-94). Overall, 69 early deaths were observed, accounting for 19% of all reported deaths. The cumulative rate of early mortality at 90 days was 6.0%. Comparing early with delayed deaths, we observed a lower frequency of deaths due to lymphoma progression (42% vs. 75%; p < 0.001) and a higher frequency due to toxicity and infections (22% vs. 4%, p < 0.001, and 22% vs. 3%, p < 0.001, respectively) for early events. A multivariable logistic analysis on 931 patients (excluding PT) confirmed an independent association of high-risk EPI (odds ratio [OR] 3.60; 95% confidence interval [CI] 1.15-11.2) and bulky disease (OR 2.08; 95% CI 1.09-3.97) with the risk of early mortality. The cumulative incidence of early mortality for older patients with DLBCL is not negligible and is mainly associated with non-lymphoma related events. For patients receiving anthracyclines, high-risk EPI and bulky disease are associated with a higher probability of early mortality.
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Affiliation(s)
- Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Alessandra Tucci
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | - Benedetta Puccini
- Hematology Department, Careggi Hospital and University of Florence, Firenze, Italy
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | - Stefano Luminari
- Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department CHIMOMO, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Sara Veronica Usai
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Elsa Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara, Italy
| | - Dario Marino
- Oncology 1 Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | - Monica Balzarotti
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Milano, Italy
| | - Luigi Petrucci
- Insitute of Hematology, Department of Tanslational and Precision Medicine "La Sapienza", University of Roma, Roma, Italy
| | - Agostino Tafuri
- Hematology, University Hospital S.Andrea-Sapienza, Roma, Italy
| | - Annalisa Arcari
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Barbara Botto
- Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Stefan Hohaus
- University Policlinico Gemelli Foundation-IRCCS, Catholic University of Sacred Heart, Roma, Italy
| | - Roberto Sartori
- Oncohematology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padova, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Guido Gini
- Clinic of Hematology AOU Ospedali Riuniti Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Wael Al Essa
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, and Azienda Ospedaliero-Universitaria Maggiore della Carità Novara, Novara, Italy
| | - Gerardo Musurca
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Luca Nassi
- Hematology Department, Careggi Hospital and University of Florence, Firenze, Italy
| | - Rosa Daffini
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | - Caterina Mammi
- Gruppo Amici dell'Ematologia GRADE-Onlus Foundation, Reggio Emilia, Italy
| | | | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Michele Spina
- Division of Medical Oncology and Immunerelated Tumors, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Francesco Merli
- Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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8
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Hung YS, Chang H, Wang PN, Kuo MC, Su YJ, Hung CY, Hsueh SW, Yeh KY, Ho YW, Chou WC. Pretreatment frailty is an independent prognostic factor among elderly patients with B-cell lymphoma undergoing immunochemotherapy: A prospective observational cohort study in Taiwan. Asia Pac J Clin Oncol 2023; 19:62-70. [PMID: 35403372 DOI: 10.1111/ajco.13661] [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: 06/01/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND/PURPOSE Frailty is a common clinical syndrome among the elderly; however, it is frequently neglected in patients with hematological malignancies, especially among the Asian population. This study is aimed to evaluate the prevalence and effect of frailty on survival outcomes in elderly Asian patients with B-cell lymphoma. METHODS We prospectively enrolled 76 consecutive patients with age ≥ 65 years and newly diagnosed B-cell lymphoma and were receiving immunochemotherapy in a medical center in Taiwan between August 2016 and December 2017. The frailty of all patients was assessed using a comprehensive geriatric assessment (CGA) within 7 days before immunochemotherapy. RESULTS Twenty-seven patients (36%) were allocated to the frail group based on CGA. With a median follow-up duration of 26.5 (range, 1.7-39.8) months, the 1- and 2-year survival rates were 68% and 58%, respectively, for all group of patients. In patients in the non-frail group, the 1-year and 2-year survival rates were 81% and 71%, respectively, compared to 44% and 33%, respectively, in the frail group (hazard ratio [HR], 3.57, 95% confidence interval [CI], 1.74-7.30; p = 0.001). Age ≥ 75years (adjusted HR 2.57, 95% CI 1.02-6.47, p = 0.045), presence of B-symptoms (adjusted HR 2.43, 95% CI 1.05-5.60, p = 0.038), and frailty (adjusted HR 3.03, 95% CI 1.29-7.11, p = 0.011) were independent prognostic factors in the multivariate analysis. CONCLUSION Frailty significantly influenced the survival outcome as an independent prognostic factor in elderly patients with B-cell lymphoma undergoing immunochemotherapy. Pretreatment frailty assessment is critical to assist clinicians and patients with B-cell lymphoma with prognosis prediction and counseling on an appropriate treatment goal.
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Affiliation(s)
- Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung Chang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Nan Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chung Kuo
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jiun Su
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hema-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kun-Yun Yeh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Ya-Wen Ho
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hema-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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9
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Bocci G, Pelliccia S, Orlandi P, Caridi M, Banchi M, Musuraca G, Di Napoli A, Bianchi MP, Patti C, Anticoli-Borza P, Battistini R, Casaroli I, Lanzolla T, Tafuri A, Cox MC. Remarkable Remission Rate and Long-Term Efficacy of Upfront Metronomic Chemotherapy in Elderly and Frail Patients, with Diffuse Large B-Cell Lymphoma. J Clin Med 2022; 11:7162. [PMID: 36498736 PMCID: PMC9739472 DOI: 10.3390/jcm11237162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/19/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
The upfront treatment of very elderly and frail patients with diffuse large B-cell lymphoma (DLBCL) is still a matter of debate. Herein, we report results of the metronomic all-oral DEVEC [prednisolone/deltacortene®, vinorelbine (VNR), etoposide (ETO), cyclophosphamide] combined with i.v. rituximab (R). This schedule was administered as a first line therapy in 22 elderly/frail DLBCL subjects (median age = 84.5 years). In 17/22 (77%) patients, the Elderly-IPI-score was high. After a median follow-up of 24 months, 15 patients had died: seven (50%) for causes unrelated to DLBCL or its treatment, six (40%) for progression, and two (13%) for multiorgan failure. Six treatment-pertinent serious-adverse-events occurred. At the end of induction, 14/22 (64%) achieved complete remission; overall survival and event-free survival at 24 months were both 54% (95% CI = 32−72%), while the time to progression was 74% (95% CI = 48−88%). Furthermore, antiproliferative and proapoptotic assays were performed on DLBCL/OCI-LY3 cell-line using metronomic VNR and ETO and their combination. Both metronomic VNR and ETO had concentration-dependent antiproliferative (IC50 = 0.036 ± 0.01 nM and 7.9 ± 3.6 nM, respectively), and proapoptotic activities in DLBCL cells. Co-administration of the two drugs showed a strong synergism (combination index < 1 and dose reduction index > 1) against cell proliferation and survival. This low-dose schedule seems to compare favourably with intravenous-CHEMO protocols used in the same subset. Indeed, the high synergism shown by metronomic VRN+ETO in in vitro studies, explains the remarkable clinical responses and it allows significant dose reductions.
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Affiliation(s)
- Guido Bocci
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Sabrina Pelliccia
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Paola Orlandi
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Matteo Caridi
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, 06125 Perugia, Italy
| | - Marta Banchi
- Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gerardo Musuraca
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) Srl—IRCCS, 47014 Meldola, Italy
| | - Arianna Di Napoli
- UOC Anatomia Patologica, Azienda Ospedaliera Universitaria Sant’Andrea & Department of Clinical and Molecular Medicine Sapienza University, 00185 Rome, Italy
| | - Maria Paola Bianchi
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Caterina Patti
- UOC Oncoematologia, Azienda Villa Sofia-Cervello, 90146 Palermo, Italy
| | | | | | - Ivana Casaroli
- Haematology Department, San Gerardo Hospital Monza, 20900 Monza, Italy
| | - Tiziana Lanzolla
- UOC Medicina Nucleare, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Agostino Tafuri
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
| | - Maria Christina Cox
- UOC Ematologia, Azienda Ospedaliera Universitaria Sant’Andrea, 00189 Rome, Italy
- Hematology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
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10
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Longitudinal Body Composition Changes Detected by [ 18F]FDG PET/CT during and after Chemotherapy and Their Prognostic Role in Elderly Hodgkin Lymphoma. Cancers (Basel) 2022; 14:cancers14205147. [PMID: 36291931 PMCID: PMC9601090 DOI: 10.3390/cancers14205147] [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] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this retrospective study was to investigate the longitudinal body changes in terms of muscle and adipose areas and their prognostic role in elderly (>65 years) patients affected by Hodgkin lymphoma (HL). Skeletal muscle area (SMA), skeletal muscle index (SMI), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), and total dispose tissue (TAT) were measured using the computed tomography (CT) of fluorine-18-fluorodeoxyglucose positron emission tomography/CT ([18F]FDG PET/CT) in 88 patients who undertook baseline, interim (after two cycles of chemotherapy), and end-of-treatment (after 6 cycles of chemotherapy) PET/CT scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured at pre-treatment PET/CT. Metabolic response applying Deauville score was evaluated at interim and end-of-treatment PET/CT. Survival curves, such as progression free survival (PFS) and overall survival (OS), were calculated for the whole population. Fifty-eight (66%) patients had sarcopenia at baseline and sarcopenia rate increased at interim scan with 68 (77%) cases and at end-of-treatment scan with 73 (83%) cases. Muscular areas (SMA and SMI) declined significantly during the treatment (p < 0.001), decreasing from baseline by 5% and 7% at interim and end-of-treatment evaluation, respectively. Instead, VAT, SAT, IMAT, and TAT increased significantly over this time (p < 0.001). Sarcopenia was significantly related with comprehensive geriatric assessment. PET/CT response at interim and end-of-treatment, MTV, TLG, and baseline sarcopenia were independent prognostic factors for PFS. Instead, metabolic response at interim and end-of-treatment PET, baseline sarcopenia, ΔSMI at interim, and ΔSMI at end-of-treatment for OS were independent prognostic factors.
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11
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Selected Domains within a Comprehensive Geriatric Assessment in Older Patients with Non-Hodgkin Lymphoma are Highly Associated with Frailty. Clin Hematol Int 2022; 4:35-43. [PMID: 35950204 PMCID: PMC9358790 DOI: 10.1007/s44228-022-00005-7] [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: 10/04/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background The incidence of Non-Hodgkin Lymphoma (NHL) is increasing, particularly among older patients who tend to have worse outcomes and can be predisposed to increased toxicities and less treatment tolerance. Therefore, a thorough pre-treatment assessment is essential. A comprehensive geriatric assessment (CGA) can be used to evaluate the older patient considering chemotherapy and is the preferred evaluation tool. However, a formal CGA is laborious, complex and time-consuming. Objectives To characterize older adults with NHL and determine the CGA variables with the greatest association to frailty in order to propose a more simplified assessment. Methods We performed a cross-sectional study using data collected from CGAs in NHL patients > 65 years admitted to our oncology service, from September 2015 to August 2017. Our evaluation parameters included: polypharmacy, a screening tool of older people's prescriptions (STOPP), the Lawton scale, Barthel index, Katz index, gait speed, a Timed Up and Go (TUG) test, a Mini-Mental state examination (MMSE), the Yesavage and Gijon scales, a Mini-nutritional assessment (MNA), a Geriatric Syndromes assessment, and a Cumulative Illness Rating Scale-Geriatric (CIRS-G). The formal CGA was comprised of nine domains; frailty was defined as an impairment in > 2 domains. Each parameter was individually compared with frailty, and the results were used to build different multivariate models using logistic regression analyses to obtain the variables with the highest frailty association. Results A total of 253 patients were included. Their median age was 75.4 years (range 65–92), and 62.1% had > 1 impaired domain, with 39.9% considered frail. Bivariate analysis showed strong associations with age > 85 and all the geriatric parameters except for STOPP. Our final multivariate analysis resulted in 5 domains (the use of > 5 medications, a Lawton < 7, TUG > 20, Yesavage > 5, and the presence of at least one geriatric syndrome) being significantly associated with frailty and performing similarly to a CGA. Conclusion In our population of older NHL patients, an abbreviated evaluation based of only five domains, polypharmacy, TUG, Lawton scale, Yesavage scale and the presence of at least one geriatric syndrome, had similar performance to a formal CGA in determining frailty.
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12
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Petrov D, Timilshina N, Papadopoulos E, Alibhai SM. Performance of the frailty index in predicting complete remission, intensive care unit admission, and overall mortality in older and younger patients with acute myeloid leukemia receiving intensive chemotherapy. Leuk Lymphoma 2022; 63:2189-2196. [DOI: 10.1080/10428194.2022.2064993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dmitriy Petrov
- Department of Medicine, University Health Network, Toronto, Canada
| | - Narhari Timilshina
- Department of Medicine, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Shabbir M.H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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13
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Miyazaki K. Management of elderly patients with malignant lymphoma. Jpn J Clin Oncol 2022; 52:690-699. [PMID: 35435235 DOI: 10.1093/jjco/hyac056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/02/2022] [Indexed: 11/14/2022] Open
Abstract
More than half of patients with malignant lymphoma are 65 years old or older. The outcome for older patients is poorer than that for younger patients. A poor prognosis is associated with heterogeneity and consists of physical function, performance status, poor nutritional status and various comorbidities. Therefore, attention should be given to serious treatment-related toxicities. Diffuse large B-cell lymphoma is the most frequently diagnosed type of malignant lymphoma. Most patients with diffuse large B-cell lymphoma can be potentially cured with the current standard chemotherapeutic regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. However, a reduced-dose regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone or alternative treatment options might be suitable for older patients who are frail or unfit and have cardiac comorbidities. A comprehensive geriatric assessment is a potential tool for determining an appropriate therapeutic approach for each older patient. Follicular lymphoma is the second most common type of non-Hodgkin lymphoma, and the disease course is usually characterized by an indolent clinical course. Advanced follicular lymphoma with a high tumor burden has historically been treated with chemoimmunotherapy, but the treatment goal for older patients is relief of symptoms. Incorporating novel targeted agents such as brentuximab vedotin into therapies for older Hodgkin lymphoma patients might be a promising alternative to the anthracycline-containing regimen.
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Affiliation(s)
- Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
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14
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Brem EA, Li H, Beaven AW, Caimi PF, Cerchietti L, Alizadeh A, Olin R, Henry NL, Dillon H, Little RF, Laubach C, LeBlanc M, Friedberg JW, Smith SM. SWOG 1918: A phase II/III randomized study of R-miniCHOP with or without oral azacitidine (CC-486) in participants age 75 years or older with newly diagnosed aggressive non-Hodgkin lymphomas - Aiming to improve therapy, outcomes, and validate a prospective frailty tool. J Geriatr Oncol 2022; 13:258-264. [PMID: 34686472 PMCID: PMC9879719 DOI: 10.1016/j.jgo.2021.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 01/28/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is an aggressive but potentially curable malignancy; however, cure is highly dependent on the ability to deliver intensive, anthracycline-based chemoimmunotherapy. Nearly one third of cases of DLBCL occur in patients over age 75 years, and advanced age is an important adverse feature in prognostic models. Despite this incidence in older patients, there is no clear accepted standard of care due to under-representation of this group in large randomized clinical trials. Furthermore, insufficient assessments of baseline frailty and prediction of toxicity hamper clinical decision-making. Here, we present an ongoing randomized study of R-miniCHOP chemoimmunotherapy with or without oral azacitidine (CC-486, Onureg) for patients age 75 and older with newly diagnosed DLBCL and associated aggressive lymphomas. The incorporation of an oral hypomethylating agent is based on increased tumor methylation as a biologic feature of older patients with DLBCL and a desire to minimize the injection burden for this population. This is the first randomized study in this population conducted in North America by the National Clinical Trials Network (NCTN) and will enroll up to 422 patients including 40 patients in a safety run-in phase. This study incorporates an objective assessment of baseline frailty (the FIL Tool) and a serial comprehensive geriatric assessment (CGA). Key correlative tests will include circulating tumor DNA (ctDNA) assays at pre-specified timepoints to explore if ctDNA quantity and methylation patterns correlate with response. S1918 has the potential to impact future trial design and to change the standard of care for patients 75 years and older with aggressive lymphoma given its randomized design, prospective incorporation of geriatric assessments, and exploration of ctDNA correlatives. Trial registration: The trial is registered with ClinicalTrial.gov Identifier NCT04799275.
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Affiliation(s)
| | - Hongli Li
- SWOG Statistics and Data Management Center, Seattle, WA,Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Anne W. Beaven
- Lineberger Comprehensive Cancer Center University of North Carolina, Chapel Hill, NC
| | - Paolo F. Caimi
- Case Western Reserve University School of Medicine, Case Comprehensive Cancer Center, Cleveland, OH
| | | | - Ash Alizadeh
- Stanford University Medical Center, Stanford, CA
| | - Rebecca Olin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | - Richard F. Little
- National Cancer Institute, Cancer Therapy Evaluation Program (CTEP), Bethesda, MD
| | | | - Michael LeBlanc
- SWOG Statistics and Data Management Center, Seattle, WA,Fred Hutchinson Cancer Research Center, Seattle, WA
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15
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Lee SF, Vellayappan BA, Wong LC, Chiang CL, Chan SK, Wan EYF, Wong ICK, Lambert PC, Rachet B, Ng AK, Luque-Fernandez MA. Cardiovascular diseases among diffuse large B-cell lymphoma long-term survivors in Asia: a multistate model study. ESMO Open 2022; 7:100363. [PMID: 35026723 PMCID: PMC8760397 DOI: 10.1016/j.esmoop.2021.100363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We modeled the clinical course of a cohort of diffuse large B-cell lymphoma (DLBCL) patients with no prior cardiovascular diseases (CVDs) using a multistate modeling framework. PATIENTS AND METHODS Data on 2600 patients with DLBCL diagnosed between 2000 and 2018 and had received chemotherapy with or without radiotherapy were obtained from a population-wide electronic health database of Hong Kong. We used the Markov illness-death model to quantify the impact of doxorubicin and various risk factors (therapeutic exposure, demographic, comorbidities, cardiovascular risk factors, and lifestyle factors which included smoking) on the clinical course of DLBCL (transitions into incident CVD, lymphoma death, and other causes of death). RESULTS A total of 613 (23.6%) and 230 (8.8%) of 2600 subjects died of lymphoma and developed incident CVD, respectively. Median follow-up was 7.0 years (interquartile range 3.8-10.8 years). Older ages [hazard ratio (HR) for >75 versus ≤60 years 1.88; 95% confidence interval (CI) 1.25-2.82 and HR for 61-75 versus ≤60 years 1.60; 95% CI 1.12-2.30], hypertension (HR 4.92; 95% CI 2.61-9.26), diabetes (HR 1.43; 95% CI 1.09-1.87), and baseline use of aspirin (HR 5.30; 95% CI 3.93-7.16) were associated with an increased risk of incident CVD. In a subgroup of anticipated higher-risk patients (aged 61-75 years, smoked, had diabetes, and received doxorubicin), we found that they remained on average 7.9 (95% CI 7.2-8.8) years in the DLBCL state and 0.1 (95% CI 0.0-0.4) years in the CVD state, if they could be followed up for 10 years. The brief time in the CVD state is consistent with the high chance of death in patients who developed CVD. Other causes of death have overtaken DLBCL-related death after about 5 years. CONCLUSIONS In this Asian population-based cohort, we found that incident CVDs can occur soon after DLBCL treatment and continued to occur throughout survivorship. Clinicians are advised to balance the risks and benefits of treatment choices to minimize the risk of CVD.
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Affiliation(s)
- S F Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - B A Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - L C Wong
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - C L Chiang
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong; Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
| | - S K Chan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong
| | - E Y-F Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong
| | - I C-K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong; Research Department of Policy and Practice, School of Pharmacy, University College London, London, UK
| | - P C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - B Rachet
- Department of Non-Communicable Disease Epidemiology, ICON Group, London School of Hygiene and Tropical Medicine, London, UK
| | - A K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M A Luque-Fernandez
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Non-Communicable Disease and Cancer Epidemiology, Instituto de Investigacion Biosanitaria de Granada (ibs.GRANADA), Andalusian School of Public Health, Granada, Spain.
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16
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Adel M, Fawzy A, Younes J, ElRasad S. Role of Positron Emission Tomography with 2-Deoxy-2-[fluorine-18]fluoro-D-glucose Integrated with Computed Tomography in the Evaluation of Hepatic Metabolic Activity due to Steatosis in Lymphoma Patients and its Impact on Deauville Score. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Liver uptake of 2-Deoxy-2-[fluorine-18]fluoro-D-glucose integrated (18F-FDG) is taken as the reference tissue in interpretation of Deauville score (DS), which is considered a response assessment.
AIM: This study was conducted to evaluate the prevalence of hepatic steatosis in patients with lymphoma and the impact of hepatic metabolic activity due to steatosis on 18F-FDG liver uptake and its effect on DS.
MATERIAL AND METHODS: This prospective study was conducted on 77 cases. Seventy-seven patients had baseline positron emission tomography/computed tomography (PET/CT), 69 patients had interim PET/CT, 31 patients had end of treatment (EOT) PET/CT, and 3 patients had follow-up (FU) PET/CT after EOT. The study included 49 female patients (63.6%) and 28 male patients (36.4%). The mean age = 39.5 + 13. Forty-one patients (53.2%) diagnosed as non-Hodgkin lymphoma [HL] while 36 patients (46.8%) diagnosed as HL. Steatosis was diagnosed on the unenhanced CT part of PET/CT examinations using a cutoff value of 42 Hounsfield units. Both maximum standardized uptake value (SUVmax) and SULmax were recorded on the liver and the tumor target lesion. DS was then computed.
RESULTS: Among 77 cases, prevalence of steatosis in baseline (10/77, 12.9%), interim (13/69, 18.8%), and EOT/FU (4/31, 12.9%), there was no significant difference in hepatic steatosis during their time course of their treatment. There was correlation between Liver SUVmax with body mass index (BMI) in each of interim and EOT PET/CT. Regarding SULmax, there was no correlation with BMI. There was no change in interpretation of DS using either SUVmax or SULmax.
CONCLUSION: Steatosis has no practical issue regarding liver metabolic activity (either SUVmax or SULmax) in interpretation of DS. Liver SUVmax is affected by body weight. Unlike, SULmax is not affected by body weight.
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17
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Zhang H, Liu M, Li Q, Lyu C, Jiang YY, Meng JX, Li JY, Deng Q. Evaluation of the safety and efficacy of humanized anti-CD19 chimeric antigen receptor T-cell therapy in older patients with relapsed/refractory diffuse large B-cell lymphoma based on the comprehensive geriatric assessment system. Leuk Lymphoma 2021; 63:353-361. [PMID: 34587859 DOI: 10.1080/10428194.2021.1986216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy has led to unprecedented results to date in relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), yet its clinical application in elderly patients with R/R DLBCL remains somewhat limited. In this study, a total of 31 R/R DLBCL patients older than 65 years of age were enrolled and received humanized anti-CD19 CAR T-cell therapy. Patients were stratified into a fit, unfit, or frail group according to the comprehensive geriatric assessment (CGA). The fit group had a higher objective response (OR) rate (ORR) and complete response (CR) rate than that of the unfit/frail group, but there was no difference in the part response (PR) rate between the groups. The unfit/frail group was more likely to experience AEs than the fit group. The peak proportion of anti-CD19 CAR T-cells in the fit group was significantly higher than that of the unfit/frail group. The CGA can be used to effectively predict the treatment response, adverse events, and long-term survival.
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Affiliation(s)
- Huan Zhang
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Man Liu
- Department of Surgery Plastic, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Qing Li
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Cuicui Lyu
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Yan-Yu Jiang
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Juan-Xia Meng
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Jing-Yi Li
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Qi Deng
- Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
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18
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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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19
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Briand M, Gerard S, Gauthier M, Garric M, Steinmeyer Z, Balardy L. Impact of therapeutic management and geriatric evaluation on patient of eighty years and older with diffuse large B-cell lymphoma on survival: A systematic review. Eur J Haematol 2021; 108:3-17. [PMID: 34496073 DOI: 10.1111/ejh.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Diffuse large B cell lymphoma (DLBCL) is an aggressive disease. The first-line treatment is well defined in young patients; however, in oldest old patients treatment remains unclear. OBJECTIVES To investigate the impact of therapeutics management and geriatric evaluation on survival in aged patients with DLBCL. METHODS We performed a systematic review of PubMed and COCHRANE databases of published report on elderly patients (median age 80 and above) with DLBCL, from January 2002 to January 2020. RESULTS We included 32 studies (6 prospective and 26 retrospective). Patients treated with anthracyclines-containing chemoimmunotherapy had a 2-year overall survival (OS) of 59%-74.3% in prospective studies and 48.1-64.6% in retrospective studies. With less intensive treatment without anthracyclines, 2-year OS was 28%-53%. Without specific treatment, median OS was 2 months. History of falls and severe comorbidities were associated with a decreased survival. CONCLUSIONS Chemoimmunotherapy with anthracyclines increases survival in selected very elderly patients in comparison with less intensive regimen. Geriatric assessment, in particular altered mobility disorders and severe comorbidities, is predictive of survival and should be associated with the therapeutic decision. More comparative studies are needed to guide the management of frailer patients.
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Affiliation(s)
- Marguerite Briand
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stephane Gerard
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Martin Gauthier
- Department of Hematology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.,Department of Internal Medicine, Centre Hospitalier de Cahors, Cahors, France
| | - Marie Garric
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Zara Steinmeyer
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laurent Balardy
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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20
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Martinez-Calle N, Isbell LK, Cwynarski K, Schorb E. Advances in treatment of elderly primary central nervous system lymphoma. Br J Haematol 2021; 196:473-487. [PMID: 34448202 DOI: 10.1111/bjh.17799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comorbidities influence individualised treatment approaches and geriatric assessment tools are increasingly utilised. Optimal induction treatment remains high-dose methotrexate-based immunochemotherapy, delivery is feasible in the majority of patients and the goal of treatment remains achieving complete remission. Consolidation strategies are also relevant in the elderly, aiming to maximise duration of response and quality of life (QoL). Potential options include high-dose therapy with haematopoietic stem cell consolidation, non-myeloablative chemotherapy and whole-brain radiotherapy. Efficacy of novel agents, such as Bruton tyrosine kinase inhibitors and lenalidomide, have been reported; these represent an alternative for elderly patients unfit for chemotherapy. Prognosis remains poor, improvement of outcomes in this age group is urgently needed.
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Affiliation(s)
- Nicolas Martinez-Calle
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lisa K Isbell
- Department of Haematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - Elisabeth Schorb
- Department of Haematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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21
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Zilioli VR, Albano D, Arcari A, Merli F, Coppola A, Besutti G, Marcheselli L, Gramegna D, Muzi C, Manicone M, Camalori M, Ciammella P, Colloca G, Tucci A. Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience. J Cachexia Sarcopenia Muscle 2021; 12:1042-1055. [PMID: 34114749 PMCID: PMC8350211 DOI: 10.1002/jcsm.12736] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/31/2021] [Accepted: 05/21/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness-based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment-related toxicities and worse survival in various solid tumours, but its impact in ecHL is unknown. The aim of this retrospective multicentre study was to investigate the prognostic role of sarcopenia in ecHL. METHODS We included newly diagnosed >64 years old cHL patients who performed a baseline comprehensive geriatric assessment and high-dose computed tomography (CT) or 18fluorine-fluorodeoxyglucose positron emission tomography/CT before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2 /m2 ) by the analysis of high-dose CT or low-dose positron emission tomography/CT images at the L3 level. The specific cut-offs for the SMI were determined by receiver operator curve analysis and compared with those proposed in literature and studied in diffuse large B-cell lymphoma. Survival functions [progression-free survival [PFS] and overall survival (OS)] were calculated for the whole population and for different subgroups defined as per different sarcopenia cut-off levels. RESULTS We included 154 patients (median age 71 years old, 76 female). The median L3-SMI was 42 cm2 /m2 . The specific cut-off derived in our male population was 45 cm2 /m2 ; using this cut-off, 27 male patients (35%) were defined as sarcopenic. After a median follow-up of 5.9 years, the overall 5-year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic male patients compared with non-sarcopenic (PFS 31% vs. 61%, P = 0.008; OS 51% vs. 74%, P = 0.042). Applying diffuse large B-cell lymphoma-derived sarcopenic thresholds, there were no significant differences between sarcopenic and non-sarcopenic patients for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male patients using Namakura cut-off. The comprehensive geriatric assessment-determined frail functional status was an independent adverse prognostic factor for both female and male patients. CONCLUSIONS Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male patients with unfavourable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of patients with worse outcome.
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Affiliation(s)
| | - Domenico Albano
- Division of Nuclear Medicine, ASST Spedali Civili, Brescia, Italy
| | - Annalisa Arcari
- Division of Hematology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Francesco Merli
- Division of Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Coppola
- Division of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Besutti
- Division of Radiology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Fondazione Italiana Linfomi Onlus, Trial Office Modena, Modena, Italy
| | | | - Cristina Muzi
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Moana Manicone
- Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Division of Radiotherapy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Camalori
- Division of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Patrizia Ciammella
- Division of Radiotherapy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Colloca
- Division of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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22
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Merli F, Luminari S, Tucci A, Arcari A, Rigacci L, Hawkes E, Chiattone CS, Cavallo F, Cabras G, Alvarez I, Fabbri A, Re A, Puccini B, Barraclough A, Delamain MT, Ferrero S, Usai SV, Ferrari A, Cencini E, Pennese E, Zilioli VR, Marino D, Balzarotti M, Cox MC, Zanni M, Di Rocco A, Lleshi A, Botto B, Hohaus S, Merli M, Sartori R, Gini G, Nassi L, Musuraca G, Tani M, Bottelli C, Kovalchuk S, Re F, Flenghi L, Molinari A, Tarantini G, Chimienti E, Marcheselli L, Mammi C, Spina M. Simplified Geriatric Assessment in Older Patients With Diffuse Large B-Cell Lymphoma: The Prospective Elderly Project of the Fondazione Italiana Linfomi. J Clin Oncol 2021; 39:1214-1222. [PMID: 33577377 DOI: 10.1200/jco.20.02465] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To prospectively validate the use of a simplified geriatric assessment (sGA) at diagnosis and to integrate it into a prognostic score for older patients with diffuse large B-cell lymphoma (DLBCL). METHODS We conducted the prospective Elderly Project study on patients with DLBCL older than 64 years who underwent our Fondazione Italiana Linfomi original geriatric assessment (oGA) (age, Cumulative Illness Rating Scale for Geriatrics, activities of daily living, and instrumental activities of daily living) before treatment. Treatment choice was left to the physician's discretion. The primary end point was overall survival (OS) (ClinicalTrials.gov identifier: NCT02364050). RESULTS We analyzed 1,163 patients (median age 76 years), with a 3-year OS of 65% (95% CI, 62 to 68). Because at multivariate analysis on oGA, age > 80 years retained an independent correlation with OS, we also developed a new, simplified version of the GA (sGA) that classifies patients as fit (55%), unfit (28%), and frail (18%) with significantly different 3-year OS of 75%, 58%, and 43%, respectively. The sGA groups, International Prognostic Index, and hemoglobin levels were independent predictors of OS and were used to build the Elderly Prognostic Index (EPI). Three risk groups were identified: low (23%), intermediate (48%), and high (29%), with an estimated 3-year OS of 87% (95% CI, 81 to 91), 69% (95% CI, 63 to 73), and 42% (95% CI, 36 to 49), respectively. The EPI was validated using an independent external series of 328 cases. CONCLUSION The Elderly Project validates sGA as an objective tool to assess fitness status and defines the new EPI to predict OS of older patients with DLBCL.
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Affiliation(s)
- Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.,Department CHIMOMO, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Tucci
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | - Annalisa Arcari
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Luigi Rigacci
- Haematology Unit, Careggi University Hospital, Firenze, Italy
| | - Eliza Hawkes
- Department of Oncology and Clinical Haematology, Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Melbourne, Australia
| | - Carlos S Chiattone
- Santa Casa Medical School, Sao Paulo, Brazil.,Samaritano Hospital, Sao Paulo, Brazil
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino," Torino, Italy
| | - Giuseppina Cabras
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Isabel Alvarez
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Alessandro Re
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | | | | | | | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino," Torino, Italy
| | - Sara Veronica Usai
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Elsa Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara, Italy
| | | | - Dario Marino
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Monica Balzarotti
- Department of Medical Oncology and Hematology, Humanitas Clinical Research Hospital-IRCCS, Rozzano (MI), Italy
| | | | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Alice Di Rocco
- Institute of Hematology, Department of Translational and Precision Medicine "Sapienza," University of Roma, Roma, Italy
| | - Arben Lleshi
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
| | - Barbara Botto
- Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Stefan Hohaus
- University Policlinico Gemelli Foundation-IRCCS, Catholic University of the Sacred Heart, Roma, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Roberto Sartori
- Department of Clinical and Experimental Oncology, Oncohematology Unit, Veneto Institute of Oncology, IOV-IRCCS, Castelfranco Veneto (TV), Italy
| | - Guido Gini
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Luca Nassi
- Hematology, AOU Maggiore della Carità and University of Eastern Piedmont, Novara, Italy
| | - Gerardo Musuraca
- Hematology Unit, IRCCS-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) SRL, Meldola (FC), Italy
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Chiara Bottelli
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | - Sofia Kovalchuk
- Haematology Unit, Careggi University Hospital, Firenze, Italy
| | - Francesca Re
- Hematology and BMT Center, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Leonardo Flenghi
- Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Giuseppe Tarantini
- Haematology and BMT Unit, Ospedale Monsignor R. Dimiccoli, Barletta, Italy
| | - Emanuela Chimienti
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
| | | | - Caterina Mammi
- Gruppo Amici dell'Ematologia GRADE-Onlus Foundation, Reggio Emilia, Italy
| | - Michele Spina
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
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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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Cox MC, Nusca SM, Di Landro F, Marsilli G, Stella G, Sigona M, Ponzelli F, Passerini Desideri J, Di Gregorio F, Santoboni F, Vetrano M, Trischitta D, Manno R, Vulpiani MC. Exercise training (ET) in adult and elderly patients receiving anti-lymphoma treatments is feasible and may improve the provision of care. Leuk Lymphoma 2020; 62:560-570. [PMID: 33231126 DOI: 10.1080/10428194.2020.1842396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Lymphoma treatments can produce adverse effects leading to a reduced quality-of-life (QoL). Besides, in patients ≥65years, it can promote an accelerated geriatric decay. We conducted a prospective study on supervised Exercise-Training (ET), in consecutive, patients aged 18-80years, during anti-lymphoma treatments.16/30 (53%), median-age = 65.5y, participated to the ET sessions, this was the Interventional Group (IG); 14/30 (47%), median-age = 63y, were the Reference Group (RG). Both groups participated to the fitness and the QoL assessments, at baseline (T0), 3-months (T1) and 6-months (T2) after the start of chemotherapy. The adherence to the ET program was 50% (95% CI:36-64%). The IG showed substantial improvements compared to the CG in cardiorespiratory fitness (Cooper test) at both T1 and T2 and in all the functional domain of the QoL questionnaire (QLQ-C30) at T2. This study showed ET, during chemotherapy, is feasible and safe, even in patients ≥65 years. Furthermore, it may improve the provision of care.
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Affiliation(s)
- Maria Christina Cox
- Haematology Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy.,Haematology Department, King's College Hospital NHS Trust, London, UK.,Università Telematica San Raffaele, Italy
| | - Sveva Maria Nusca
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, PhD Course in "Translational Medicine and Oncology", 'Sapienza' University of Rome, Rome, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Francesca Di Landro
- Haematology Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - Gabriella Marsilli
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Giulia Stella
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Matilde Sigona
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Federica Ponzelli
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Jasmine Passerini Desideri
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | | | - Flavia Santoboni
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | - Mario Vetrano
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, PhD Course in "Translational Medicine and Oncology", 'Sapienza' University of Rome, Rome, Italy
| | - Donatella Trischitta
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
| | | | - Maria Chiara Vulpiani
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, PhD Course in "Translational Medicine and Oncology", 'Sapienza' University of Rome, Rome, Italy.,Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, 'Sapienza' University of Rome, Italy
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All-oral metronomic DEVEC schedule in elderly patients with peripheral T cell lymphoma. Cancer Chemother Pharmacol 2020; 86:841-846. [PMID: 33070248 PMCID: PMC7568761 DOI: 10.1007/s00280-020-04172-3] [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: 07/04/2020] [Accepted: 10/06/2020] [Indexed: 11/20/2022]
Abstract
Purpose Peripheral T cell lymphomas (PTCLs) have an overall poor prognosis. Indeed, registry data in elderly patients show that the median progression-free survival (mPFS) following first- and second-line therapies are only 6.7 and 3.1 months, respectively. The aim of the study is to show the activity of metronomic chemotherapy, a regular administration of low chemotherapeutic drug doses allowing a favourable toxicity profile, on elderly PTCL patients. Methods We report a series of 17 PTCL patients, treated with the all-oral metronomic schedule DEVEC (prednisolone–etoposide–vinorelbine–cyclophosphamide) in four Italian centres. Patients 5/17 (29.4%) were treatment-naïve (naïve) and 12/17 (70.6%) were relapsed-refractory (RR), respectively. The median age was 83 years (range 71–87) and 71.5 years (range 56–85) for naïve and RR, respectively. In vitro activity of metronomic vinorelbine (VNR), etoposide (ETO) and their concomitant combination on HH, a PTCL cell line, was also assessed. Results Histology: PTCL-not-otherwise-specified = 12; angioimmunoblastic = 2; NK/T nasal type = 1; adult-type leukaemia lymphoma = 1, transformed Mycosis Fungoides = 1. The overall response rate was 80 and 58% in naïve and RR, respectively; whereas the PFS was 20 in naïve (95% CI 0–43) and 11 months (95% CI 4.2–17.8) in RR. The occurrence of relevant adverse events was 23.5%, which was managed with ETO dose reduction. In vitro experiments showed that both metronomic VNR and ETO caused a significant inhibitory activity on HH cells and a strong synergism when administered concomitantly. Conclusion All-oral DEVEC showed an encouraging activity and acceptable toxicity. This schedule deserves further studies in elderly PTCL also for assessing combinations with targeted drugs. Electronic supplementary material The online version of this article (10.1007/s00280-020-04172-3) contains supplementary material, which is available to authorized users.
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Bai J, Han H, Feng R, Li J, Wang T, Zhang C, Liu H. Comprehensive Geriatric Assessment (CGA): A Simple Tool for Guiding the Treatment of Older Adults with Diffuse Large B-Cell Lymphoma in China. Oncologist 2020; 25:e1202-e1208. [PMID: 32436258 PMCID: PMC7418339 DOI: 10.1634/theoncologist.2019-0738] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We aimed to validate a simple Comprehensive Geriatric Assessment (CGA) in older adults with diffuse large B-cell lymphoma (DLBCL) in China and to evaluate the tolerability and efficacy of CGA-driven therapy. MATERIALS AND METHODS In total, 78 patients with DLBCL aged ≥60 years were evaluated using CGA with the following parameters: age ≥ 80 years, activities of daily living (ADL), instrumental ADL, and modified cumulative illness rating score for geriatrics. Patients were grouped as fit, unfit, or frail. Patients classified as fit received standard-dose rituximab plus CHOP, whereas patients in the latter two groups received reduced-dose or reduced-agent therapy. The overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and toxicities in the three groups were evaluated. RESULTS According to the CGA, 45 (57.5%) patients were classified as fit, 5 (6.4%) as unfit, and 28 (35.9%) as frail. The ORR was 82.1% (64/78) among all the patients, including 55 patients (70.6%) who achieved complete response and 9 patients (11.5%) who achieved partial response. In the fit and unfit + frail groups, it achieved 97.8% and 60.6%, respectively. In total, 26 (33.3%) patients (10/45 [22.2%] fit and 16/33 [48.5%] unfit + frail) showed disease progression or recurrence. The median follow-up time was 18 months (range, 5-62). The 3-year OS and PFS rates were 82% and 58%, respectively. There were no treatment-related deaths. CONCLUSION A simple CGA in older adults with DLBCL may be an effective tool for guiding therapeutic strategies in China. IMPLICATIONS FOR PRACTICE Diffuse large B-cell lymphoma (DLBCL) is the most common malignant lymphoma in older adults. The simple tool, Comprehensive Geriatric Assessment (CGA), is proved to be an effective method to identify older adults with DLBCL who are suitable for standard-dose R-CHOP regimen therapy. This is the first prospective trial in China to evaluate the tolerability and efficacy of CGA-driven therapy for older adults with DLBCL, and the result showed that this simple CGA may be an effective tool for guiding therapeutic strategies.
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Affiliation(s)
- Jie‐Fei Bai
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Hui‐Xiu Han
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Ru Feng
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Jiang‐Tao Li
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Ting Wang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Chun‐Li Zhang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Hui Liu
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
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Chou WC, Chang H, Wang PN, Kuo MC, Wu JH, Lin TL, Su YJ, Kao HW, Ou CW, Hung CY, Hsueh SW, Hung YS. Application of comprehensive geriatric assessment in predicting early mortality among elder patients with B-cell lymphoma receiving immunochemotherapy. Eur J Haematol 2020; 105:399-407. [PMID: 32472712 DOI: 10.1111/ejh.13457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Early mortality, defined as death within 120 days after initiated antitumor therapy, is an important issue especially for elder patients with B-cell lymphoma. This study aimed to evaluate the clinical value of comprehensive geriatric assessment (CGA) in early mortality prediction in elderly patients with B-cell lymphoma receiving immunochemotherapy. METHODS Seventy-six consecutive patients with newly diagnosed B-cell lymphoma receiving immunochemotherapy from a medical center in Taiwan were prospectively enrolled. Patients were divided into fit (n = 49) and frail (n = 27) groups per pretreatment CGA for early mortality comparison. RESULTS The early mortality rate in our patient cohort was 16% (n = 12): from 6% in patients with no CGA domain impairment to 43% in patients with ≥4 CGA domain impairment. The early mortality rate was 6% and 33% in fit and frail patients (odds ratio, 7.67; 95% CI, 1.86-31.6; P = .005), respectively. Frailty was the significant predictor for early mortality in univariate and multivariate analysis. CONCLUSION In this study, the number of geriatric domain impairment is positively associated with the early mortality risk in elderly patients with B-cell lymphoma. Therefore, CGA can help clinicians to identify the risk of early mortality in elderly patients and provide alternative treatment.
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Affiliation(s)
- Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung Chang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Nan Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chung Kuo
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Hou Wu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Liang Lin
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jiun Su
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Wen Kao
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Che-Wei Ou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Molga A, Wall M, Chhetri R, Wee LY, Singhal D, Edwards S, Singhal N, Ross D, To LB, Caughey G, Shakib S, Germing U, To T, Hiwase D. Comprehensive geriatric assessment predicts azacitidine treatment duration and survival in older patients with myelodysplastic syndromes. J Geriatr Oncol 2020; 11:114-120. [DOI: 10.1016/j.jgo.2019.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/31/2018] [Accepted: 02/04/2019] [Indexed: 12/27/2022]
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Sakatoku K, Takeoka Y, Miura A, Araki T, Fujitani Y, Yamamura R, Nakamae H, Ohta K, Hino M. Combination of Frailty Status and Comorbidity Score Improves the Stratification of Survival in Patients With Myelodysplastic Syndrome Owing to Good Predictive Capability for Infection-related Mortality. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:799-805. [DOI: 10.1016/j.clml.2019.09.610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/08/2019] [Accepted: 09/20/2019] [Indexed: 01/28/2023]
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Harkins RA, Chang A, Patel SP, Lee MJ, Goldstein JS, Merdan S, Flowers CR, Koff JL. Remaining challenges in predicting patient outcomes for diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:959-973. [PMID: 31513757 PMCID: PMC6821591 DOI: 10.1080/17474086.2019.1660159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and is an aggressive malignancy with heterogeneous outcomes. Diverse methods for DLBCL outcomes assessment ranging from clinical to genomic have been developed with variable predictive and prognostic success.Areas covered: The authors provide an overview of the various methods currently used to estimate prognosis in DLBCL patients. Models incorporating cell of origin, genomic features, sociodemographic factors, treatment effectiveness measures, and machine learning are described.Expert opinion: The clinical and genetic heterogeneity of DLBCL presents distinct challenges in predicting response to therapy and overall prognosis. Successful integration of predictive and prognostic tools in clinical trials and in a standard clinical workflow for DLBCL will likely require a combination of methods incorporating clinical, sociodemographic, and molecular factors with the aid of machine learning and high-dimensional data analysis.
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Affiliation(s)
- R. Andrew Harkins
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | - Andres Chang
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
| | | | - Michelle J. Lee
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | | | - Selin Merdan
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
- Georgia Institute of Technology, Atlanta, Georgia 30332-0002, USA
| | | | - Jean L. Koff
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
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Çağlayan Ç, Goldstein JS, Ayer T, Rai A, Flowers CR. A population-based multistate model for diffuse large B-cell lymphoma-specific mortality in older patients. Cancer 2019; 125:1837-1847. [PMID: 30707765 PMCID: PMC6509004 DOI: 10.1002/cncr.31981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/17/2018] [Accepted: 12/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite effective therapies, outcomes for diffuse large B-cell lymphoma (DLCBL) remain heterogeneous in older individuals due to comorbid diseases and variations in disease biology. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, the authors conducted a multistate survival analysis of 11,780 patients with DLBCL who were aged ≥65 years at the time of diagnosis (2002-2009). Cox proportional hazards models were used to specify the impact of prognostic factors on overall survival and cause-specific deaths, and the Aalen-Johansen estimator was used to project the course of DLBCL over time with or without standard therapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). RESULTS Advanced age (hazard ratio [HR] for ages 71-75 years: 1.25; HR for ages 76-80 years: 1.46; HR for ages 81-85 years: 1.88; and HR for age ≥86 years: 2.26), DLBCL stage (HR for Ann Arbor stage II: 1.28; HR for stage III: 1.54; and HR for stage IV: 1.95), Charlson Comorbidity Index (CCI) ≥1 (HR for CCI of 1, 1.15; and HR for CCI >1, 1.37), and not being married (HR, 1.12) were associated with an increased risk of DLBCL-specific death. Being female (HR, 0.91) and of higher socioeconomic status (HR, 0.91) were associated with a lower risk of DLBCL-related mortality after therapy. For patients treated with R-CHOP (3610 patients), the risk of death due to DLBCL was 14.0% and 18.6%, respectively, at 2 and 5 years of treatment and plateaued afterward, confirming a 5-year "cure" point while receiving R-CHOP among older patients. CONCLUSIONS Conducting a survival analysis over a large data set, the current study evaluated competing risks for death within a multistate modeling framework, and identified age, sex, and CCI as risk factors for DLBCL-specific and other causes of death.
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Affiliation(s)
- Çağlar Çağlayan
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Ashish Rai
- Outcomes Research, Surveillance and Health Services Research Program, American Cancer Society Inc, Atlanta, Georgia
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The metronomic all-oral DEVEC is an effective schedule in elderly patients with diffuse large b-cell lymphoma. Invest New Drugs 2019; 37:548-558. [PMID: 31028663 DOI: 10.1007/s10637-019-00769-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Abstract
Metronomic-chemotherapy (M-CHT) has been rarely assessed in non-Hodgkin-lymphoma (NHL). Therefore, in 2011 we started experimenting a new all-oral M-CHT schedule termed DEVEC (Deltacortene®, etoposide, vinorelbine, cyclophosphamide, +/-Rituximab) in diffuse-large-B-cell lymphoma (DLBCL) patients. Methods Patients with stage Ib-IV were enrolled as follows: 1) treatment-naïve, frail ≥65y, or unfit ≥85y; and 2) relapsed/refractory (R/R) ≥55y. Data were prospectively collected from six Italian centres and compared for efficacy to two reference groups, treated with established iv Rituximab-CHT in 1st and 2nd line respectively. Results from April-2011 to March-2018, 17/51(33%) naïve, 21/51(41%) refractory and 13/51(25.5%) relapsed patients started DEVEC; 39/51(76.5%) were de-novo DLBCL; 10/51(19.6%) transformed-DLBCL and 2/51(3.9%) unclassifiable-DLBCL/classical-Hodgkin-lymphoma. The median age was 85y (range=77-93) and 78y (range=57-91) in naïve and R/R respectively and overall the DEVEC patients had very poor features compared to the reference. The rate of grade≥3 haematological-AEs was 43%(95CI=29-58%): G3-neutropenia was the most frequent; grade≥3 extra-haematological-AEs was 13.7% (95%CI=5.4-25.9%), the most frequent was infection. One-year OS and PFS were 67% and 61% for naive, 60% and 50% for reference-naïve respectively; Cox proportional hazard ratio (Cox-PH-ratio) for OS and PFS were 0.69 (95%CI=0.27-1.76;p=.441) and 0.68 (95%CI=0.28-1.62;p=.381) respectively. One-year OS and PFS were 48% and 39% in the R/R, 36% and 17% in the reference-R/R respectively; Cox-PH-ratio for OS and PFS, were 0.76 (95%CI=0.42-1.40; p=.386) and 0.48 (95%CI=0.28-0.82; p=.007) respectively. Conclusion The favourable activity of DEVEC compared to a real-life series and the convenience of an oral administration, may possibly lay the groundwork for a paradigm-shift in the treatment of elderly DLBCL.
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Predictive value of each geriatric assessment domain for older patients with cancer: A systematic review. J Geriatr Oncol 2019; 10:859-873. [PMID: 30926250 DOI: 10.1016/j.jgo.2019.02.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/23/2019] [Accepted: 02/14/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND A geriatric assessment (GA) is increasingly used to help guide treatment decisions in older patients with cancer. However, there is no consensus regarding which domains should be included in the GA. In addition, the field of geriatric oncology moves very fast and as a result many new studies have been published since the last review in 2015. Therefore, the objective of this systematic review is to evaluate which domains of the GA could predict patient-related treatment outcomes of older patients with cancer and thereby should be included in a GA. METHODS A systematic literature search was performed for publications in English or Dutch between September 2006 and July 2017 addressing the association between individual domains of the GA and mortality, postoperative complications, or systemic treatment-related outcomes in older patients with cancer. RESULTS Eight different domains were evaluated in 46 publications, namely functional status, nutritional status, cognition, mood, physical function, fatigue, social support, and falls. All eight domains were predictive for at least one of the investigated outcomes but the results were quite variable across studies. Physical function and nutritional status were the domains most often associated with mortality and systemic treatment-related outcomes, and the domain physical function was most often associated with postoperative complications. CONCLUSION Overall, this review demonstrates that the GA should minimally consist of physical function and nutritional status, when the aim is to predict patients-related outcomes of older patients with cancer, although the results are quite heterogeneous. For the other domains, the findings are too inconsistent to draw conclusions about their overall predictive ability.
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Zhang CL, Feng R, Li JT, Tian Y, Wang T, Liu H. [Comprehensive geriatric assessment can predict the clinical outcomes of elderly patients with diffuse large B cell lymphoma in China]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:271-276. [PMID: 29779319 PMCID: PMC7342144 DOI: 10.3760/cma.j.issn.0253-2727.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: To validate comprehensive geriatric assessment (CGA) system in Chinese elderly diffuse large B cell lymphoma (DLBCL) patients. Methods: Patients ≥ 65 years of age who had been diagnosed with de novo DLBCL were screened for eligibility (n=99). CGA was performed during staging procedures through application of the following instruments: age, comorbidity score according to the Cumulative Illness Rating Score for Geriatrics(CIRS-G), activities of daily living (ADL), and instrumental activities of daily living (IADL). Results: All patients were classified as "ft" , "unfit" , and "frail" . Forty-nine (49.5%), 14 (14.1%), and 34 (36.4%) patients were categorized into the fit, unfit, and frail groups, respectively. The overall response rate was 91.8%, 64.3%, and 69.5% in fit, unfit, and frail group, respectively (χ(2)=9.311, P=0.007). Eleven (22.4%), 7 (50.0%), and 16(44.4%) patients showed disease relapse/progression in fit, unfit, and frail group, respectively (χ(2)=6.309, P=0.040). The 2-year probability of overall survival was 90.6%, 43.0%, and 58.5% in fit, unfit, and frail group, respectively (χ(2)=14.774, P=0.001). The 2-year probability of progression-free survival was 72.9%, 32.5%, and 37.3% in fit, unfit, and frail group, respectively (χ(2)=11.038, P=0.004). Conclusion: The CGA index can predict the clinical outcomes of elderly DLBCL patients in China.
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Affiliation(s)
- C L Zhang
- Department of Hematology, Beijing Hospital, Beijing 100730, China
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Abstract
PURPOSE OF REVIEW Older adults with hematologic malignancy are a growing demographic. Estimating risk of chemotherapy toxicity based on age alone is an unreliable estimate of quality of life, functional capacity, or risk of treatment complications. RECENT FINDINGS Dedicated geriatric assessment tools can aid the clinician in identifying geriatric syndromes such as frailty, resulting in improved prognostication to decrease morbidity and mortality. Frailty is not synonymous with individual performance status and is dynamic. Establishing the patient goals, values, and preferences is central to the consideration of malignant hematology decision process. Careful considerations of available data on the patient's prognosis based on estimated life expectancy, geriatric assessment data, and age-specific cancer mortality, with and without treatment, can reconcile the risks and benefits. Assessments of frailty can aid the clinical feasibility and burden of the treatment to the patient and family in the context of each patient's unique needs.
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Geriatric screening tools predict survival outcomes in older patients with diffuse large B cell lymphoma. Ann Hematol 2018; 98:669-678. [DOI: 10.1007/s00277-018-3551-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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Ørum M, Gregersen M, Jensen K, Meldgaard P, Damsgaard EMS. Frailty status but not age predicts complications in elderly cancer patients: a follow-up study. Acta Oncol 2018; 57:1458-1466. [PMID: 30280625 DOI: 10.1080/0284186x.2018.1489144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. MATERIAL Patients aged ≥70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. METHODS CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. PRINCIPAL RESULTS Patients (N = 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.
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Affiliation(s)
- Marianne Ørum
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Nakamura N, Ninomiya S, Matsumoto T, Nakamura H, Kitagawa J, Shiraki M, Hara T, Shimizu M, Tsurumi H. Prognostic impact of skeletal muscle assessed by computed tomography in patients with acute myeloid leukemia. Ann Hematol 2018; 98:351-359. [PMID: 30341537 DOI: 10.1007/s00277-018-3508-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/02/2018] [Indexed: 12/16/2022]
Abstract
Skeletal muscle atrophy and loss of adipose tissue, referred to as sarcopenia and adipopenia, respectively, are often observed in cancer patients. We investigated the impact of sarcopenia and adipopenia on clinical outcomes in 90 adult patients with newly diagnosed acute myeloid leukemia (AML) who received induction chemotherapy. Computed tomography (CT) before treatment revealed sarcopenia in 39 patients (43%) and adipopenia in 35 patients (39%). We analyzed the treatment efficacy of induction chemotherapy and survival outcomes. Three-year overall survival (OS) was 35% in the sarcopenic group and 67% in the non-sarcopenic group (P < 0.001). Three-year OS was 33% in the adipopenic group and 67% in the non-adipopenic group (P < 0.005). Multivariate analysis showed an association between sarcopenia and lower OS (hazard ratio, 2.27; 95% confidence interval, 1.11-4.79; P < 0.05), with other prognostic factors of performance status > 2 (P < 0.05) and adverse cytogenetic risk (P < 0.05). In elderly patients over 60 years old, 3-year OS was 0% for the sarcopenic group and 49% for the non-sarcopenic group (P < 0.0005). These results indicate the prognostic values of sarcopenia in adult patients with AML.
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Affiliation(s)
- Nobuhiko Nakamura
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Soranobu Ninomiya
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Takuro Matsumoto
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroshi Nakamura
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Junichi Kitagawa
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Makoto Shiraki
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takeshi Hara
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hisashi Tsurumi
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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Can we incorporate geriatric assessment in the management of acute lymphoblastic leukemia in older adults? J Geriatr Oncol 2018; 9:296-301. [DOI: 10.1016/j.jgo.2018.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/07/2018] [Accepted: 03/23/2018] [Indexed: 02/03/2023]
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Storti S, Spina M, Pesce EA, Salvi F, Merli M, Ruffini A, Cabras G, Chiappella A, Angelucci E, Fabbri A, Liberati AM, Tani M, Musuraca G, Molinari A, Petrilli MP, Palladino C, Ciancia R, Ferrario A, Gasbarrino C, Monaco F, Fraticelli V, De Vellis A, Merli F, Luminari S. Rituximab plus bendamustine as front-line treatment in frail elderly (>70 years) patients with diffuse large B-cell non-Hodgkin lymphoma: a phase II multicenter study of the Fondazione Italiana Linfomi. Haematologica 2018; 103:1345-1350. [PMID: 29748444 PMCID: PMC6068040 DOI: 10.3324/haematol.2017.186569] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/03/2018] [Indexed: 01/22/2023] Open
Abstract
We conducted a phase II study to assess activity and safety profile of bendamustine and rituximab in elderly patients with untreated diffuse large B-cell lymphoma (DLBCL) who were prospectively defined as frail using a simplified version of the Comprehensive Geriatric Assessment (CGA). Patients had to be over 70 years of age, with histologically confirmed DLBCL. Frail patients were those younger than 80 years with a frail profile at CGA or older than 80 years with an unfit profile. Treatment consisted of 4-6 courses of bendamustine [90 mg/m2 days (d)1-2] and rituximab (375 mg/m2 d1) administered every 28 days. Other main study end points were complete remission rate and the rate of extra-hematologic adverse events. Forty-nine patients were enrolled of whom 45 were confirmed eligible. Overall, 24 patients achieved a complete remission (53%; 95%CI: 38-68%) and the overall response rate was 62% (95%CI: 47-76%). The most frequent grade 3-4 adverse event was neutropenia (37.8%). Grade 3-4 extra-hematologic adverse events were observed in 7 patients (15.6%; 95%CI: 6.5-29.5%); the most frequent was grade 3 infection in 2 patients. With a median follow up of 33 months (range 1-52), the median progression-free survival was ten months (95%CI: 7-25). The study shows promising activity and manageable toxicity profile of BR combination as first-line therapy for patients with DLBCL who are prospectively defined as frail according to a simplified CGA, as adopted in this trial (clinicaltrials.gov identifier: 01990144).
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Affiliation(s)
- Sergio Storti
- Department of Hematology, Universita' Cattolica Sacro Cuore Campobasso, Italy
| | - Michele Spina
- Division of Oncology A, National Cancer Institute Aviano, Italy
| | | | - Flavia Salvi
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Michele Merli
- Department of Hematology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy
| | | | | | - Annalisa Chiappella
- Department of Hematology, Città della Salute Hospital and University, Torino, Italy
| | | | - Alberto Fabbri
- Azienda Ospedaliera Universitaria Senese, U.O.C. Ematologia, Siena, Italy
| | | | - Monica Tani
- Department of Hematology, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Gerardo Musuraca
- Department of Hematology, IRCCS -Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Meldola, Italy
| | | | - Maria Pia Petrilli
- Department of Hematology, Universita' Cattolica Sacro Cuore Campobasso, Italy
| | - Carmela Palladino
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Rosanna Ciancia
- Division of Oncology A, National Cancer Institute Aviano, Italy
| | - Andrea Ferrario
- Department of Hematology, Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi, Varese, Italy
| | | | - Federico Monaco
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Vincenzo Fraticelli
- Department of Hematology, Universita' Cattolica Sacro Cuore Campobasso, Italy
| | - Annalisa De Vellis
- Department of Hematology, Universita' Cattolica Sacro Cuore Campobasso, Italy
| | - Francesco Merli
- Department of Hematology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Modena, Italy
| | - Stefano Luminari
- Department of Hematology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Modena, Italy .,Department of Clinical Diagnostic and Public Health Medicine, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
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Liu H, Zhang CL, Feng R, Li JT, Tian Y, Wang T. Validation and Refinement of the Age, Comorbidities, and Albumin Index in Elderly Patients with Diffuse Large B-Cell Lymphoma: An Effective Tool for Comprehensive Geriatric Assessment. Oncologist 2018; 23:722-729. [PMID: 29317552 PMCID: PMC6067934 DOI: 10.1634/theoncologist.2017-0361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/07/2017] [Indexed: 01/22/2023] Open
Abstract
Diffuse large B‐cell lymphoma (DLBCL) is one of the most frequent types of malignant lymphoma in elderly people; thus, the management of elderly DLBCL patients is important. This study aimed to validate the ACA index in Chinese elderly DLBCL patients and to refine the ACA index to propose a more effective comprehensive geriatric assessment method that could serve as a guide for optimal personalized therapy for elderly DLBCL patients treated with R‐CHOP. Background. We aimed to validate and refine the Age, Comorbidities, and Albumin (ACA) index in elderly Chinese patients with diffuse large B‐cell lymphoma (DLBCL) and propose a more effective method for comprehensive geriatric assessment (CGA). Materials and Methods. Patients ≥65 years of age who had been diagnosed with de novo DLBCL in the Institute of Hematology, Beijing Hospital, were screened for eligibility (n = 99). Results. Based on the ACA index, 39, 31, 26, and 3 patients were categorized into the “excellent,” “good,” “moderate,” and “poor” groups, respectively. The 2‐year treatment‐related mortality rate was significantly higher and the survival rates poorer in the ACA “moderate to poor” group compared with those of the ACA “good” and “excellent” groups. Multivariable model analysis identified two independent predictors of overall survival: the instrumental activities of daily living (IADL) scale and the ACA index. IADL scores of 6 to 7 and the ACA “good” group were assigned 1 point; IADL scores ≤5 and the ACA “moderate to poor” group were assigned 2 points. Based on these data, we created a three‐category system (IADL ACA index [IACA index]): low risk, score 0; intermediate risk, score 1 to 2; and high risk, score 3 to 4. The IACA index could effectively discriminate the response rates, overall survival, and progression‐free survival rates in elderly patients with DLBCL. Conclusion. We observed that the ACA index could partially predict the clinical outcomes of elderly DLBCL patients in China. Based on this index, we proposed the IACA index as an effective tool for CGA in DLBCL. Implications for Practice. Diffuse large B‐cell lymphoma (DLBCL) is one of the most frequent types of malignant lymphoma in elderly people, and identifying patients suitable for curative therapy is critical in the improvement of clinical outcomes. Recently, some authors proposed the Age, Comorbidities, and Albumin (ACA) index. Combining the use of the instrumental activities of daily living (IADL) scale and the ACA index, this article describes the IADL ACA index (IACA index), which is an effective tool for comprehensive geriatric assessment in DLBCL.
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Affiliation(s)
- Hui Liu
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Chun-Li Zhang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Ru Feng
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Jiang-Tao Li
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Yuan Tian
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
| | - Ting Wang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Beijing, People's Republic of China
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Cox MC, Musuraca G, Battistini R, Casaroli I, Zoli V, Anticoli-Borza P, Arcari A, Naso V, di Landro F, Fabbri F, Tafuri A, Bocci G, Merli F. Aggressive lymphomas of the elderly: the DEVEC metronomic chemotherapy schedule fits the unfit. Br J Haematol 2017; 183:819-822. [PMID: 29193017 DOI: 10.1111/bjh.15039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Gerardo Musuraca
- Haematology unit, IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | | | | | - Valerio Zoli
- Haematology unit, AO San Camillo Forlanini, Rome, Italy
| | | | | | | | | | - Francesca Fabbri
- Haematology unit, IRCCS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Agostino Tafuri
- Haematology unit, AOU Sant'Andrea, Rome, Italy.,Department of Clinic and Molecular Medicine, Sapienza University, Roma, Italy
| | - Guido Bocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Merli
- Haematology unit, Azienda Ospedaliera Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
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43
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Frailty and the management of hematologic malignancies. Blood 2017; 131:515-524. [PMID: 29141942 DOI: 10.1182/blood-2017-09-746420] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/18/2017] [Indexed: 12/13/2022] Open
Abstract
The majority of blood cancers occur in the elderly. This fact conspires with an aging population in many countries to make rigorous assessment for frailty increasingly important for hematologic oncologists. In this review, we first define frailty and its relevance for patients with hematologic malignancy. Next, we review current data regarding the effect of domains of frailty on outcomes for blood cancers including myelodysplastic syndromes, acute leukemia, non-Hodgkin lymphomas such as chronic lymphocytic leukemia, and multiple myeloma. Finally, after presenting assessment and treatment options for the practicing hematologist, we propose elements of a new research agenda for geriatric hematology: the exchange of age limits for rigorous frailty screening, development of disease-specific measures, and inclusion of functional and patient-reported outcomes alongside survival.
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44
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Paul U, Richter J, Stuhlmann-Laiesz C, Kreuz M, Nagel I, Horn H, Staiger AM, Aukema SM, Hummel M, Ott G, Spang R, Rosenwald A, Feller AC, Cogliatti S, Stein H, Hansmann ML, Moller P, Szczepanowski M, Burkhardt B, Pfreundschuh M, Schmitz N, Loeffler M, Trümper L, Siebert R, Klapper W. Advanced patient age at diagnosis of diffuse large B-cell lymphoma is associated with molecular characteristics including ABC-subtype and high expression of MYC. Leuk Lymphoma 2017; 59:1213-1221. [PMID: 28838257 DOI: 10.1080/10428194.2017.1365851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The incidence of diffuse large B-cell lymphoma (DLBCL) increases with age being patient age at diagnosis an adverse prognostic factor. However, elderly patients are often underrepresented in common studies. To investigate the effect between age and biological characteristics in DLBCL, we analyzed data of 1534 patients encompassing all adult age groups, enriched for the age ≥75 years. Follicular lymphoma (FL) grade 3B with histopathological characteristics of DLBCLs were included. Gender, centroblastic cytology, FL grade 3B morphology, CD10 expression, and ABC/non-GCB-subtype were significantly associated with age after correction for multiple testing and after adjusting for cohorts. Analysis of a subgroup points towards an association of MYC expression with age. Our data indicate that biological features of DLBCL and FL grade 3B are associated with increasing age among adult patients. The prevalence of the ABC/non-GCB-subtype in elderly patients suggests that therapies targeting this molecular subtype should be specifically explored in this subgroup.
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Affiliation(s)
- Ulrike Paul
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
| | - Julia Richter
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
| | | | - Markus Kreuz
- c Institute for Medical Informatics , Statistics and Epidemiology University of Leipzig , Leipzig , Germany
| | - Inga Nagel
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,d Institute of Pharmacology , Christian-Albrecht University , Kiel , Germany
| | - Heike Horn
- e Department of Clinical Pathology , Robert-Bosch-Krankenhaus , Stuttgart , Germany.,f Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen , Germany
| | - Annette M Staiger
- e Department of Clinical Pathology , Robert-Bosch-Krankenhaus , Stuttgart , Germany.,f Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen , Germany
| | - Sietse M Aukema
- b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
| | - Michael Hummel
- g Institute of Pathology, Campus Benjamin Franklin , Charité Universitätsmedizin , Berlin , Germany
| | - German Ott
- e Department of Clinical Pathology , Robert-Bosch-Krankenhaus , Stuttgart , Germany.,f Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen , Germany
| | - Rainer Spang
- h Institute of Functional Genomics , University of Regensburg , Regensburg , Germany
| | - Andreas Rosenwald
- i Institute of Pathology , University Würzburg and Comprehensive Cancer Mainfranken , Würzburg , Germany
| | | | - Sergio Cogliatti
- k Institute of Pathology , Kantonal Hospital St Gallen , St Gallen , Switzerland
| | | | - Martin-Leo Hansmann
- m Institute of Pathology , University Hospital Frankfurt , Frankfurt , Germany
| | - Peter Moller
- n Institute of Pathology , University Medical Center Ulm , Ulm , Germany
| | - Monika Szczepanowski
- b Hematopathology Section , Christian-Albrecht University , Kiel , Germany.,o Department of Internal Medicine II, Hematology Laboratory , Christian-Albrecht University , Kiel , Germany
| | - Birgit Burkhardt
- p Department of Pediatric Hematology and Oncology , NHL-BFM Study Center, University Children's Hospital , Münster , Germany
| | - Michael Pfreundschuh
- q Medizinische Klinik I , Saarland University Medical School , Homburg/Saar , Germany
| | - Norbert Schmitz
- r Department of Hematology , Asklepios Klinik St. Georg , Hamburg , Germany
| | - Markus Loeffler
- c Institute for Medical Informatics , Statistics and Epidemiology University of Leipzig , Leipzig , Germany
| | - Lorenz Trümper
- s Department of Hematology and Oncology , Georg-August University , Göttingen , Germany
| | - Reiner Siebert
- a Institute of Human Genetics , Christian-Albrecht University , Kiel , Germany.,t Institute of Human Genetics , University Medical Center Ulm & University Ulm , Ulm , Germany
| | - Wolfram Klapper
- b Hematopathology Section , Christian-Albrecht University , Kiel , Germany
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Role of anthracycline and comprehensive geriatric assessment for elderly patients with diffuse large B-cell lymphoma. Blood 2017; 130:2180-2185. [PMID: 28814386 DOI: 10.1182/blood-2017-05-736975] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
Abstract
Survival outcome for elderly patients with newly diagnosed diffuse large B-cell lymphoma remains suboptimal in the rituximab era. In this systematic review, we summarize available evidence relevant to the inclusion of anthracycline in upfront chemoimmunotherapy for these elderly patients and highlight the need of prospective clinical trials. With limited prospective data, we find that pretreatment comprehensive geriatric assessment accurately predicts survival and treatment-related toxicities, suggesting its potential role in guiding overall treatment decision-making.
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Go SI, Park MJ, Song HN, Kim HG, Kang MH, Kang JH, Kim HR, Lee GW. A comparison of pectoralis versus lumbar skeletal muscle indices for defining sarcopenia in diffuse large B-cell lymphoma - two are better than one. Oncotarget 2017; 8:47007-47019. [PMID: 28388585 PMCID: PMC5564540 DOI: 10.18632/oncotarget.16552] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/28/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUNDS Sarcopenia is known to be associated with poor clinical outcome in patients with diffuse large B-cell lymphoma (DLBCL). There is no consensus concerning the optimal method to define sarcopenia in DLBCL. METHODS We retrospectively reviewed 193 DLBCL patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. Sarcopenia was classified by the region where the pretreatment skeletal muscle index (SMI) was measured. RESULTS Both the sarcopenia-L3 and sarcopenia-pectoralis muscle (PM) groups had increased incidences of severe treatment-related toxicities and treatment discontinuation compared with the non-sarcopenia-L3 and non-sarcopenia-PM groups, respectively. The sarcopenia-L3 and non-sarcopenia-L3 groups had 5-year overall survival (OS) rates of 40.5% and 67.8% (p < 0.001), respectively. The sarcopenia-PM and non-sarcopenia-PM groups had 5-year OS rates of 35.9% and 69.0% (p < 0.001), respectively. When the sarcopenia-L3 alone and sarcopenia-PM alone groups were compared, there were no differences in baseline characteristics, treatment toxicity, or survival. In multivariate analysis, when compared with the non-sarcopenia-both group, OS was significantly worse in the sarcopenia-both group (HR, 2.480; 95% CI, 1.284 - 4.792; p = 0.007), but not in patients with either sarcopenia-L3 alone or sarcopenia-PM alone (p = 0.151). CONCLUSIONS L3- and PM-SMIs are equally useful to define sarcopenia, which is related to intolerance to R-CHOP therapy and to worse survival in patients with DLBCL. More prognostic information can be obtained when these two SMIs are combined to define sarcopenia.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Back Muscles/pathology
- Cyclophosphamide/adverse effects
- Cyclophosphamide/therapeutic use
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Female
- Humans
- Kaplan-Meier Estimate
- Lumbosacral Region
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Staging
- Pectoralis Muscles/pathology
- Prednisone/adverse effects
- Prednisone/therapeutic use
- Retrospective Studies
- Rituximab
- Sarcopenia/diagnosis
- Sarcopenia/etiology
- Sarcopenia/mortality
- Treatment Outcome
- Vincristine/adverse effects
- Vincristine/therapeutic use
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Haa-Na Song
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hoon-Gu Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Myoung Hee Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hye Ree Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
- Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
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Miura K, Konishi J, Miyake T, Makita M, Hojo A, Masaki Y, Uno M, Ozaki J, Yoshida C, Niiya D, Kitazume K, Maeda Y, Takizawa J, Sakai R, Yano T, Yamamoto K, Sunami K, Hiramatsu Y, Aoyama K, Tsujimura H, Murakami J, Hatta Y, Kanno M. A Host-Dependent Prognostic Model for Elderly Patients with Diffuse Large B-Cell Lymphoma. Oncologist 2017; 22:554-560. [PMID: 28408622 DOI: 10.1634/theoncologist.2016-0260] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Decision-making models for elderly patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) are in great demand. PATIENTS AND METHODS The Society of Lymphoma Treatment in Japan (SoLT-J), in collaboration with the West-Japan Hematology and Oncology Group (West-JHOG), collected and retrospectively analyzed the clinical records of ≥65-year-old patients with DLBCL treated with R-CHOP from 19 sites across Japan to build an algorithm that can stratify adherence to R-CHOP. RESULTS A total of 836 patients with a median age of 74 years (range, 65-96 years) were analyzed. In the SoLT-J cohort (n = 555), age >75 years, serum albumin level <3.7 g/dL, and Charlson Comorbidity Index score ≥3 were independent adverse risk factors and were defined as the Age, Comorbidities, and Albumin (ACA) index. Based on their ACA index score, patients were categorized into "excellent" (0 points), "good" (1 point), "moderate" (2 points), and "poor" (3 points) groups. This grouping effectively discriminated the 3-year overall survival rates, mean relative total doses (or relative dose intensity) of anthracycline and cyclophosphamide, unanticipated R-CHOP discontinuance rates, febrile neutropenia rates, and treatment-related death rates. Additionally, the ACA index showed comparable results for these clinical parameters when it was applied to the West-JHOG cohort (n = 281). CONCLUSION The ACA index has the ability to stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of elderly patients with DLBCL treated with R-CHOP. The Oncologist 2017;22:554-560 IMPLICATIONS FOR PRACTICE: Currently, little is known regarding how to identify elderly patients with diffuse large B-cell lymphoma who may tolerate a full dose of chemotherapy or to what extent cytotoxic drugs should be reduced in some specific conditions. The Society of Lymphoma Treatment in Japan developed a host-dependent prognostic model consisting of higher age (>75 years), hypoalbuminemia (<3.7 g/dL), and higher Charlson Comorbidity Index score (≥3) for such elderly patients. This model can stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of these patients and thus help clinicians in formulating personalized treatment strategies for this growing patient population.
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Affiliation(s)
- Katsuhiro Miura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Konishi
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takaaki Miyake
- Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan
| | - Masanori Makita
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Atsuko Hojo
- Division of Hematology and Oncology, Kasukabe Medical Center, Saitama, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Masatoshi Uno
- Division of Internal Medicine, Kaneda Hospital, Okayama, Japan
| | - Jun Ozaki
- Department of Hematology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Chikamasa Yoshida
- Department of Hematology, National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan
| | - Daigo Niiya
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | - Koichi Kitazume
- Department of Hematology, Showa General Hospital, Tokyo, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomofumi Yano
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | | | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Kazutoshi Aoyama
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Hideki Tsujimura
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Jun Murakami
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masatoshi Kanno
- Oncology Center, Nara Medical University Hospital, Nara, Japan
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Goede V. Marginal zone lymphoma in elderly and geriatric patients. Best Pract Res Clin Haematol 2016; 30:158-165. [PMID: 28288711 DOI: 10.1016/j.beha.2016.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 12/28/2022]
Abstract
Approximately 50% of patients with newly diagnosed marginal zone lymphoma (MZL) are of advanced age. For the three subtypes of MZL (extranodal MZL of mucosa-associated lymphoid tissue, splenic MZL, nodal MZL), the median age at diagnosis is around 65-70 years. Due to the lack of larger studies in MZL, little is known of the prevalence of comorbidity, polypharmacy, or geriatric syndromes in older patients with MZL. The impact of these concurrent conditions on the tolerability and feasibility of diagnostic or therapeutic procedures used in MZL has not been specifically investigated. However, some extrapolations can be made from other studies in cancer, thereby raising questions about potential benefits of geriatric assessment in older patients with MZL. Core of this article is a review of recommended diagnostic and therapeutic procedures in MZL in light of potential barriers and complications that might be encountered in elderly and geriatric patients with MZL.
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Affiliation(s)
- Valentin Goede
- Dept. I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology (CIO) Bonn-Cologne, Cologne, Germany; Division of Oncogeriatrics, Dept. of Geriatric Medicine, St. Marien-Hospital, Cologne, Germany.
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Laribi K, Denizon N, Bolle D, Truong C, Besançon A, Sandrini J, Anghel A, Farhi J, Ghnaya H, Baugier de Materre A. R-CVP regimen is active in frail elderly patients aged 80 or over with diffuse large B cell lymphoma. Ann Hematol 2016; 95:1705-14. [DOI: 10.1007/s00277-016-2768-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/23/2016] [Indexed: 11/24/2022]
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50
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[An 83 year old woman with dyspnoea and oedema of the lower limbs]. Rev Esp Geriatr Gerontol 2016; 51:243-4. [PMID: 26626820 DOI: 10.1016/j.regg.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/08/2015] [Indexed: 11/23/2022]
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