The Prognostic Impact of Comorbidities in Patients with De-Novo Diffuse Large B-Cell Lymphoma Treated with R-CHOP Immunochemotherapy in Curative Intent

Kocher, Florian; Mian, Michael; Seeber, Andreas; Fiegl, Michael; Stauder, Reinhard

doi:10.3390/jcm9041005

Cited by 3 publications

(4 citation statements)

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“…This study has revealed important results in terms of demonstrating the effectiveness of CCI in our own patient population. In the study conducted by Kocher et al in 2020 [14], the effectiveness of CCI and Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) were examined in 181 patients with DLBCL. All patients received R-CHOP, and a higher CCI score was associated with a lower rate of complete response (p = 0.020).…”

Section: Discussionmentioning

confidence: 99%

Charlson Comorbidity Index (CCI) in Diffuse Large B-cell Lymphoma: A New Approach in a Multicenter Study

Eren

Serin

Atak

et al. 2022

Indian J Hematol Blood Transfus

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Purpose Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult lymphomas. The incidence of DLBCL increases with age and has a fairly rapid fatal course without treatment. Patients often have difficulty tolerating standard chemotherapy regimens due to their comorbidities. Charlson Comorbidity Index ( CCI), which is calculated by considering 19 different comorbidities, was developed in 1987 and is widely used for mortality prediction in cancer patients. Literature data on CCI and hematological malignancies are limited. Main aim in this study is to evaluate the effectiveness of CCI and compare to the International Prognostic Index (IPI) scoring system in the DLBCL patient group. Methods A total of 170 patients diagnosed with DLBCL between 1.1.2002- 1.12.2020 were included in the study. Statistical analyzes were performed among patients whose IPI and CCI scores were recorded by considering baseline data. Results The median age of patients was 58 (range: 17–84). Thirty-five (20.6%) patients had stage III and 76 (44.7%) had stage IV disease. When the CCI, IPI and ECOG scores were compared with the mortality status of the patients as a reference, AUCs were resulted as 0.628 (95% CI: 0.506–0.749), 0.563 (95% CI: 0.484–0.639) and 0.672 (95% CI: 0.596–0.743), respectively. There was no significant difference between the ROC curves of CCI, IPI and ECOG scores. Patients with a CCI score of ≥ 4 had shorter OS comperad to those with a score of < 4. Conclusion Rather than claiming that CCI is superior to IPI, ECOG or another scoring system in a single-center patient population, it should be stated that CCI is also an effective scoring system in patients diagnosed with DLBCL. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-022-01567-5.

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Section: Discussionmentioning

confidence: 99%

Charlson Comorbidity Index (CCI) in Diffuse Large B-cell Lymphoma: A New Approach in a Multicenter Study

Eren

Serin

Atak

et al. 2022

Indian J Hematol Blood Transfus

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“…In DLBCL, CCI scores above 2 were shown to be associated with a significantly higher mortality [14]. Among first-line patients receiving R-CHOP regimen, 3-year survival rate was 39% for those with a CCI score C 2 while the respective value for patients with a CCI of 0 or 1 was twice as high (81%) [15].…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

Healthcare Resource Utilization and Associated Costs of German Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Health Claims Data Analysis

et al. 2022

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Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma with increasing prevalence. Although the disease burden associated with DLBCL is high, only limited data on healthcare resource utilization (HCRU) and associated costs of German patients with DLBCL is available. Methods: Using a large claims database of the German statutory health insurance with 6.7 million enrollees, we identified patients who were newly diagnosed with DLBCL between 2011 and 2018 (index date). Treatment lines were identified based on a predefined set of medication. HCRU and related costs were collected for the entire post index period and per treatment line. Results: A total of 2495 incident DLBCL patients were eligible for the analysis. The average follow-up time after index was 41.7 months. During follow-up, 1991 patients started a first-line treatment, 868 a second-line treatment, and 354 a third-line treatment. Overall, patients spent on average (SD) 5.24 (6.17) days per month in hospital after index. While on anti-cancer treatment, this number increased to nine (10.9) in first-line, 8.7 (13.7) in second-line, and 9.4 (15.8) in third-line treatments. Overall costs per patient per month (PPPM) increased from €421 (875.70) before to €3695 (4652) after index. While on a treatment line, PPPM costs were €17,170 (10,246) in firstline, €13,362 (12,685) in second-line, and €12,112 (16,173) in third-line treatments. Timeunadjusted absolute costs sum up to €59,868 (43,331), €35,870 (37,387), and €28,832 (40,540) during first-line, second-line, and third-line treatments, respectively. The main cost drivers were hospitalizations (71% of total costs) and drug acquisition costs (18% of total costs). Conclusions: The financial burden of DLBCL in Germany is high, mainly due to hospitalization and drug costs. Therefore, there is a high medical need for new cost-effective therapeutic options that can lower the disease burden and remain financially viable to support the

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“…Indeed, while the elder age has been traditionally considered an independent poor prognostic factor in various prognostic indices for DLBCL, such as the revised International Prognostic Index (R‐IPI), the National Comprehensive Cancer Network International Prognostic Index (NCCN‐IPI), and the Kyoto Prognostic index (KPI), 5–7 the global geriatrification of society has brought substantial changes in the overall landscape of daily practice for DLBCL. Currently, more than 30% of DLBCL patients are older than 75 years at their disease onset, 1 and factors other than treatment response, such as lymphoma‐unrelated comorbidities and a high frequency of adverse events leading to intolerance to treatment, have significant prognostic impacts in elderly patients with DLBCL 8–11 …”

Section: Introductionmentioning

confidence: 99%

“…Currently, more than 30% of DLBCL patients are older than 75 years at their disease onset, 1 and factors other than treatment response, such as lymphoma-unrelated comorbidities and a high frequency of adverse events leading to intolerance to treatment, have significant prognostic impacts in elderly patients with DLBCL. [8][9][10][11] Sarcopenia is the depletion of skeletal muscle mass and muscle strength and is closely associated with aging and frailty. 12 Also, sarcopenia is biologically linked with the dysregulation of inflammatory cytokines and adipokines.…”

Section: Introductionmentioning

confidence: 99%

Skeletal muscle index impacts the treatment outcome of elderly patients with diffuse large B cell lymphoma

Niiyama‐Uchibori,

Okamoto,

Miyashita

et al. 2024

Hematological Oncology

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Sarcopenia is a crucial factor in the physical fitness of elderly individuals. This study investigated the prognostic values of multiple parameters of sarcopenia in association with established prognostic factors in elderly Japanese patients with diffuse large B cell lymphoma (DLBCL). As candidate indicators for sarcopenia, the skeletal muscle index (SMI) (cm2/m2), the psoas muscle index, the erector spinae muscle index, the visceral fat index, the subcutaneous fat index, and the visceral to subcutaneous fat area ratio at the third lumbar level were assessed by computed tomography at their initial diagnosis in 102 patients with DLBCL over 75 years old those were diagnosed and treated in our institute from 2007 to 2020. The primary endpoint was overall survival (OS), and the secondary endpoint was progression‐free survival (PFS). The median age of patients analyzed was 80 years at diagnosis. The sex‐specific cut‐offs for the indices adopted two approaches: (i) the historical cut‐off values established in the previous study for healthy Japanese individuals (Hamaguchi Y. J Cachexia Sarcopenia Muscle. 2018), and (ii) each sex‐specific lowest quartile in our cohort. As the results, SMI evaluated by the historical cut‐off and sex‐specific lowest quartile was identified as the most influential independent prognostic factor for both OS and PFS among various parameters for sarcopenia. Furthermore, we developed an elderly sarcopenia prognostic index (ESPI). ESPI, which combines SMI evaluated by the historical cut‐off and LDH > ULN, demonstrated statistically significant prognostic impacts on OS and PFS. Moreover, compared to the R‐IPI, ESPI showed the ability to identify intermediate‐risk groups and indicated a trend toward improved predictive accuracy. Our study revealed that SMI is the most appropriate assessment method for evaluating sarcopenia and the critical prognostic factor in OS and PFS of elderly patients with DLBCL.

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The Prognostic Impact of Comorbidities in Patients with De-Novo Diffuse Large B-Cell Lymphoma Treated with R-CHOP Immunochemotherapy in Curative Intent

Cited by 3 publications

References 44 publications

Charlson Comorbidity Index (CCI) in Diffuse Large B-cell Lymphoma: A New Approach in a Multicenter Study

Charlson Comorbidity Index (CCI) in Diffuse Large B-cell Lymphoma: A New Approach in a Multicenter Study

Healthcare Resource Utilization and Associated Costs of German Patients with Diffuse Large B-Cell Lymphoma: A Retrospective Health Claims Data Analysis

Skeletal muscle index impacts the treatment outcome of elderly patients with diffuse large B cell lymphoma

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