Outcome of frail elderly patients with diffuse large B-cell lymphoma prospectively identified by Comprehensive Geriatric Assessment: results from a study of the Fondazione Italiana Linfomi

Abstract

In 2003 the Fondazione Italiana Linfomi (FIL) started a clinical research program for investigating initial treatment of frail elderly patients with diffuse large B-cell lymphoma (DLBCL) identified by Comprehensive Geriatric Assessment (CGA). From 2003 to 2006, 334 elderly patients underwent CGA assessment, and 99 patients were classified as frail. Frail patients had a median age of 78 years, stage III-IV disease in 62% and age-adjusted International Prognostic Index (aaIPI) of 2-3 in 53%. Treatment consisted of several different regimens according to physician discretion. After a median follow-up of 36 months, 5-year overall survival (OS) was 28%. In multivariate analysis, aaIPI 2-3 (p = 0.005) and the presence of respiratory comorbidity (p = 0.044) were the only factors that showed independent correlation with OS. Frail patients had a poorer outcome compared with fit patients also if they were treated with rituximab-containing combination chemotherapy (hazard ratio 2.37, 95% confidence interval 1.48-3.78; p < 0.001). CGA is a valid tool to prospectively identify frail subjects among elderly patients with DLBCL.

HLA specificities are related to development and prognosis of diffuse large B-cell lymphoma

“…Moreover, several studies as in the present have previously shown the utility of aaIPI in patients .60 years in the rituximab era. 46,47 It is interesting to note that the presence of the HLA-B44 supertype characterizes a group of patients who do not respond to rituximab in which novel strategies (ie, novel monoclonal antibodies) should be tested. On the other hand, the absence of the HLA-B44 supertype is capable of identifying an extremely good-risk prognostic subgroup that has a cure rate of .90% with current therapeutic strategies.…”

Diffuse large B-cell lymphoma in adults aged 75 years and older: a single institution analysis of cause-specific survival and prognostic factors

“…Another retrospective study of 476 DLBCL patients over 80 years found that R-CHOP also showed no OS benefit compared with nonanthracycline chemotherapy [Carson et al 2012]. An epirubicin-containing regimen, with lower anthracycline dose intensity but inclusion of rituximab, produced similar response rates, event-free survival, and OS in a randomized study of DLBCL patients aged 65 years or older [Merli et al 2012].…”

Impact of comorbidities on the treatment of non-Hodgkin’s lymphoma: a systematic review

“…The number of comorbidities with a score of 3 or 4 and the sum of the score of each organ system represented comorbidity markers. CIRS-G was used in six studies [19][20][21][22]24,36]. However, the coding system was variable according to the authors.…”

“…Palliative treatment, including corticosteroids, radiation therapy or surgery alone, rituximab alone or no treatment at all, was considered in up to a third of patients in at least three studies [13,18,26] and half or more of the cohort in two other papers [22,24]. Dose reduction or number of cycles received was extremely variable and was erratically reported, and sometimes not reported at all.…”