In:
The Korean Journal of Internal Medicine, Korean Association of Internal Medicine, Vol. 39, No. 3 ( 2024-05-01), p. 501-512
Abstract:
Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL).Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson’s Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS).Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, 〈 i 〉 p 〈 /i 〉 〈 0.001; fit vs. frail, HR 4.61, 〈 i 〉 p 〈 /i 〉 〈 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30–3.53, 〈 i 〉 p 〈 /i 〉 = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, 〈 i 〉 p 〈 /i 〉 〈 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, 〈 i 〉 p 〈 /i 〉 〈 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI 〈 62.4%.Conclusions: This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.
Type of Medium:
Online Resource
ISSN:
1226-3303
,
2005-6648
DOI:
10.3904/kjim.2023.265
Language:
English
Publisher:
Korean Association of Internal Medicine
Publication Date:
2024
detail.hit.zdb_id:
2500508-X
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