The impact of age, Charlson comorbidity index, and performance status on treatment of elderly patients with diffuse large B cell lymphoma

Abstract

Treatment intensity will affect outcome in elderly patients with diffuse large B cell lymphoma (DLBCL). We retrospectively reviewed 333 DLBCL patients aged over 60 years who were diagnosed between January 2003 and December 2010 to evaluate the difference between different treatment regimens. The median age was 73 years; 56.8 % of patients received treatment with rituximab-containing regimens. In univariate analysis, patients with younger age, better performance status, early Ann Arbor stage, lower International Prognostic Index (IPI), normal serum lactate dehydrogenase, normal serum albumin, or normal serum beta-2 microglobulin received more intensive treatment regimens. In multivariate analysis, patients with younger age (p < 0.001) or better performance status (p = 0.027) received treatment of more intensive regimens. The treatment regimens were not different between patients with lower and higher Charlson comorbidity index (CCI). Female gender, normal serum beta-2 microglobulin, lower CCI, lower IPI, and treatment with more intensive regimens predicted better progression-free survival and overall survival in multivariate analysis. Patients treated with rituximab-containing regimens had better progression-free survival (median 22.2 vs. 9.9 months, p = 0.005) and better overall survival (median 34.9 vs. 21.8 months, p = 0.042) as compared to those treated without rituximab. In conclusion, our results showed that patients with younger age or better performance status received more intensive treatment. The treatment regimen was not different between patients with lower and higher CCI. Rituximab-containing regimens improved the outcome of elderly patients with DLBCL.

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

“…However, comorbidity was not associated with receiving less than 6 cycles. Surprisingly, although low comorbidity scores predicted better OS and PFS rates, they did not influence the choice of chemotherapy regimen or the ability of patients to complete the whole treatment series [19]. A single-center retrospective study confirmed the negative impact of comorbidities on survival with 3-year OS of 85 and 55% (p = 0.0026) in patients with low CCI (0 or 1) and high CCI (2 or more) scores, respectively [20].…”

“…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.…”

“…With a median STROBE score of 17 from a possible total of 22 (range: [15][16][17][18][19][20][21], the quality of reporting across studies was heterogeneous and showed room for improvement. While data on background information, study design and endpoints were generally well reported, comorbidity assessment was frequently not accurately defined, with a broad range of cut-off scores considered, and the discussion on potential sources of bias, handling of missing data and limitations of the results was either incomplete or lacking in most studies.…”

“…Fifteen out of the 21 papers reported studies conducted in NHL patients treated in the standard treatment setting [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Among them, five papers assessed tolerability or outcomes of chemotherapy, four examined the prognostic impact of comorbidity on treatment outcomes and four explored the value of geriatric assessment (GA) in NHL patients.…”

“…Of the 11 out of 15 studies addressing survival, 6 showed that comorbidity was correlated with poorer survival [17][18][19][20][21][22]: an observational population-based study showed that a CCI score of 2 or more was an independent risk factor for poorer overall survival (OS) and grade 3/4 toxicity [17]. Toxicity-related deaths were more frequently observed in patients with higher CCI scores.…”