Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B‐cell lymphoma: a Swedish lymphoma register study

Wästerlid, Tove; Mohammadi, Mohammad; Smedby, Karin E.; Glimelius, Ingrid; Bottai, Matteo; Eloranta, Sandra

doi:10.1111/joim.12849

Cited by 30 publications

(39 citation statements)

References 51 publications

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“…In contrast, comorbidity was associated with a lower relapse risk before death as comorbid patients were more likely to die of other causes. These findings are consistent with recent Swedish registry data analysing CCI as a comorbidity index [9]. Together, our data suggest that increasing age and comorbidity impacts nonlymphoma-specific mortality but not lymphoma-specific mortality.…”

Section: Discussionsupporting

confidence: 93%

Impact of intended and relative dose intensity of R‐CHOP in a large, consecutive cohort of elderly diffuse large B‐cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age

et al. 2019

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Background The increasing incidence of diffuse large B‐cell lymphoma (DLBCL) in ageing populations places a significant burden on healthcare systems. Co‐morbidity, frailty, and reduced organ and physiological reserve contribute to treatment‐related complications. The optimal dose intensity of R‐CHOP to optimize outcome across different ages with variable frailty and comorbidity burden is unclear. Objectives and Methods We examined the influence of intended (IDI) and relative (RDI) dose intensity of the combination of cyclophosphamide and doxorubicin, age and comorbidity on outcomes for DLBCL patients ≥70 years in a representative, consecutive cohort across eight UK centres (2009–2018). We determined predictors of survival using multivariable Cox regression, and predictors of recurrence before death using competing risks regression. Results Porgression‐free survival (PFS) and overall survival (OS) were significantly inferior in patients ≥80 vs. 70–79 years (P < 0.001). In contrast, 2‐year cumulative relapse incidence, when accounting for non‐relapse mortality as a competing risk, was no different between 70–79 vs. ≥80 years (P = 0.27) or comorbidity status (CIRS‐G: 0–6 vs. >6) (P = 0.27). In 70–79 years, patients with an IDI ≥80% had a significantly improved PFS and OS (P < 0.001) compared to IDI < 80%. Conversely, in patients ≥80 years, there was no difference in PFS (P = 0.88) or OS (P = 0.75) according to IDI <80% vs. ≥80%. On multivariable analysis, when comparing by age, there was a significantly higher cumulative relapse rate for patients aged 70–79 years with an IDI <80% (vs. >80%) (P = 0.04) but not for patients ≥80 years comparing IDI (P = 0.32). Conclusion ‘R‐mini‐CHOP' provides adequate lymphoma‐specific disease control and represents a reasonable treatment option in elderly patients ≥80 years aiming for cure.

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Section: Discussionsupporting

confidence: 93%

Impact of intended and relative dose intensity of R‐CHOP in a large, consecutive cohort of elderly diffuse large B‐cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age

et al. 2019

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“…However, there are only limited data outside of clinical trials assessing the effect of gender on outcomes in older patients when using the standard 375 mg/m 2 21‐day schedule. A large registry study demonstrated that male gender is associated with inferior survival by univariable analysis across all ages receiving various ‘curative' regimens [all‐cause death HR 0·81 (95% CI 0·71–0·92); lymphoma‐specific death HR 0·82 (95% CI 0·70–0·97)] (Wästerlid et al , ) but no studies exist specifically in non‐trial elderly patients, particularly those aged ≥80 years, to assess the prognostic relevance of gender in R‐CHOP‐treated patients for whom detailed dose intensity information is also known.…”

Section: Baseline Clinical Characteristics Of Elderly Dlbcl Accordingmentioning

confidence: 99%

Male gender is an independent predictor for worse survival and relapse in a large, consecutive cohort of elderly DLBCL patients treated with R‐CHOP

et al. 2019

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“…The negative prognostic impact of comorbidities is well established for non-Hodgkin lymphoma patients overall (Wieringa et al, 2014;Saygin et al, 2017;Antic et al, 2018;Wasterlid et al, 2018). For example, in a study of 962 diffuse large B-cell lymphoma (DLBCL) patients, a high comorbidity score was independently associated with a threefold increased risk of death (Antic et al, 2018), and among elderly patients comorbidity had a better discriminative power than the International Prognostic Index (IPI).…”

Section: Introductionmentioning

confidence: 99%

Comorbidities and sex differences in causes of death among mantle cell lymphoma patients – A nationwide population‐based cohort study

et al. 2019

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Summary The prognosis for mantle cell lymphoma (MCL) remains poor. Our aim was to assess the impact of comorbidities on survival and causes of death. For 1,385 MCL patients (1,009 males, 376 females) diagnosed in 2000–2014 (median age 71 years, range 22–96) comorbidities ≤ 10 years of diagnosis were classified according to the Charlson comorbidity index (CCI; 0, 1, 2+). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated to compare lymphoma‐specific and all‐cause mortality rates. Model‐based predictions were used to obtain probabilities of death. Overall, 44% had any comorbidity (CCI 1+) and 28% severe comorbidity (CCI 2+). Over a median follow‐up of 3·7 years (range 0–16), 633 (46%) died, the majority (76%) from lymphoma. Severe comorbidity was independently associated with higher all‐cause [hazard ratio (HR) = 1·52; 95% CI: 1·24–1·85) and lymphoma‐specific mortality (HR = 1·31; 95% CI: 1·04–1·65). Particularly among patients with connective tissue, renal and psychiatric diseases, and dementia. Among females with any comorbidity, non‐lymphoma deaths represented a larger proportion of all deaths, compared to males with any comorbidity. In general, more efficient lymphoma treatments need to be considered also for patients with severe comorbidity. However, among females with any comorbidity, the likelihood of non‐lymphoma death was still considerable, perhaps favouring a more liberal use of a “wait and watch” approach.

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Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B‐cell lymphoma: a Swedish lymphoma register study

Abstract: W€ asterlid T, Mohammadi M, Smedby KE,

Cited by 30 publications

References 51 publications

Impact of intended and relative dose intensity of R‐CHOP in a large, consecutive cohort of elderly diffuse large B‐cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age

Impact of intended and relative dose intensity of R‐CHOP in a large, consecutive cohort of elderly diffuse large B‐cell lymphoma patients treated with curative intent: no difference in cumulative incidence of relapse comparing patients by age

Male gender is an independent predictor for worse survival and relapse in a large, consecutive cohort of elderly DLBCL patients treated with R‐CHOP

Comorbidities and sex differences in causes of death among mantle cell lymphoma patients – A nationwide population‐based cohort study

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