Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: a prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL)

Abstract

We performed a multicenter study in order to validate the concept that a simple CGA can identify elderly DLBCL non-fit patients in whom curative treatment is not better then palliation and to analyse potential benefits of treatment modulation after further subdividing the non-fit category by CGA criteria.One-hundred-seventy-three patients aged > 69 treated with curative or palliative intent by clinical judgment only were grouped according to CGA in fit (46%), unfit (16%) and frail (38%) categories. Two-yr OS was significantly better in fit than in non-fit patients (84% vs 47%; P <.0001). Survival in unfit and frail patients was not significantly different. Curative treatment slightly improved 2-yr OS in unfit (75% vs 44%), but not in frail patients (45% vs 39%).CGA was confirmed as very efficient in identifying elderly DLBCL patients who can benefit from a curative approach. Further efforts are needed to better tailor therapies in non-fit patients.3

Role of anthracycline and comprehensive geriatric assessment for elderly patients with diffuse large B-cell lymphoma

“…In the unfit subgroup of patients (n 5 28) from the study by Tucci et al, 34 curative-intent treatment with an anthracycline-containing regimen produced a 2-year OS of 75% vs 45% (P 5 .32) for palliative treatment with anthracycline-free regimens, anthracycline-based regimens with less than 70% relative dose intensity (RDI), radiation treatment, rituximab monotherapy, or supportive care alone. The unfit subgroup of patients (n 5 22) from the study by Olivieri et al 32 all received liposomal doxorubicin.…”

“…Five prospective cohort studies, including 1 randomized controlled study, evaluated the use of CGA to guide treatment decision making in elderly patients with newly diagnosed DLBCL, are summarized in Table 2. [31][32][33][34][35] In total, 1732 patients were included in 9 retrospective studies. As shown in Table 1, most studies were small singleinstitution studies with missing data, especially data related to the comparison between anthracycline-containing or anthracycline-free regimens.…”

“…[31][32][33][34][35] In total, 452 patients were included in the 4 prospective observation studies. CGA categorized patients into fit and unfit/frail categories.…”

Integrating Oncogeriatric Tools into the Management of Chronic Lymphocytic Leukemia: Current State of the Art and Challenges for the Future

“…As CGA was able to differentiate fit versus unfit patients better than clinical judgment, they concluded that CGA is an efficient method to identify which patients should receive anthracycline-containing chemotherapy. However, these algorithms were applied prospectively in a prospective series of 173 patients [59] and are being validated in large prospective observational trials by the Fondazione Italiana Linfomi (FIL) named Elderly Project [60].…”

Frailty in Hematologic Malignancy

“…(44) Prospective studies in DLBCL confirm un-fit and frail patients who received palliative vs. curative intent had similar outcomes. (45) Others have demonstrated in older adults with both aggressive and indolent NHL that geriatric factors such as malnutrition and frailty had predictive value for treatment discontinuation and frailty and hemoglobin were independent predictors of mortality. (46)…”