Introduction: Treatment choice in elderly patients (pts) with Diffuse Large B‐Cell Lymphoma (DLBCL) is challenging. A simplified CGA (sCGA) based on ADL (Activity of Daily Living), IADL (Instrumental ADL) and CIRS‐G (Comorbidity Index Rating Scale for Geriatrics) scales has demonstrated to be better than clinical judgement to stratify pts. To confirm the impact of sCGA, we conducted a prospective observational study on the outcome of a large series of elderly pts with DLBCL. Methods: Pts were enrolled if ≥65 years, with an untreated de novo DLBCL. sCGA was available at a web based platform that classified pts as FIT (F), UNFIT (U), and FRAIL (FR), as shown in Table 1. According to anthracycline doses treatment was classified as curative (≥70%), intermediate (<70%) or palliative (no anthracycline). Primary study endpoint was Overall Survival (OS). Results: Form December 2013 to December 2017, 1353 pts have been registered by 37 centres and 1207 were eligible. Median age was 76 years (65‐94), 68% had stage III‐IV, and 55% had an IPI ≥3; 500 (42%), 304 (25%), and 403 (33%) were classified as F, U and FR, respectively. A significant difference among groups was observed in the rate of B symptoms (F 22%, U 27%, FR 31%; p = 0.01), ECOG PS >1 (F 8%, U 15%, FR 38%; p<0.001), anemia (F 34%, U 40%, FR 54%; p<0.001), and IPI ≥3 (F 50%; U 56%; FR 63%; p<0.001). Data on treatment were available in 1164 pts: curative in 89%, 53%, and 36% of F, U, and FR pts, respectively; intermediate in 10%, 39%, and 31%, palliative in <1%, 8%, and 33% of pts. With a median follow up of 29 months (1‐59) 3y‐OS was 64%; according to sCGA the OS was significantly different in the three geriatric groups (Fig. 1). F pts had a significant better 3y‐OS when treated with a curative approach in comparison with intermediate (77% vs 57%, p = 0.003); the use of a curative vs intermediate approach did not affect the outcome of U and FR pts (U: 72% vs 67%, p = 0.257; FR: 63% vs 54%, p = 0.364). The use of palliative approach had a negative impact in all groups. Conclusion: This large prospective observational study on unselected elderly DLBCL pts shows that sCGA is a useful tool to identify three groups of pts with significant different outcome. Our results confirm that curative treatment (R‐CHOP or like) is the standard of care in F pts. In U and FR pts, the intermediate approach improves outcome compared to palliation and is superimposable with curative treatment. FR group warrants further characterization to better define the risk/benefit ratio of treatment.
THE ELDERLY PROJECT BY THE FONDAZIONE ITALIANA LINFOMI: A PROSPECTIVE COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) OF 1353 ELDERLY PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA / Spina, M.; Merli, F.; Puccini, B.; Cavallo, F.; Cabras, M.G.; Fabbri, A.; Angrilli, F.; Zilioli, V.R.; Marino, D.; Balzarotti, M.; Ladetto, M.; Cox, M.C.; Petrucci, L.; Arcari, A.; Gini, G.; Chiappella, A.; Hohaus, S.; Musuraca, G.; Merli, M.; Sartori, R.; Nassi, L.; Tani, M.; Re, F.; Flenghi, L.; Molinari, A.; Kovalchuk, S.; Bottelli, C.; Ferrero, S.; Dessì, D.; Cencini, E.; Pennese, E.; Marcheselli, L.; Mammi, C.; Luminari, S.; Tucci, A.. - In: HEMATOLOGICAL ONCOLOGY. - ISSN 0278-0232. - ELETTRONICO. - 37:(2019), pp. 248-250. [10.1002/hon.58_2630]
THE ELDERLY PROJECT BY THE FONDAZIONE ITALIANA LINFOMI: A PROSPECTIVE COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) OF 1353 ELDERLY PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA
Puccini, B.;PETRUCCI, LIVIO;MOLINARI, AUGUSTA;Kovalchuk, S.
;Cencini, E.;
2019
Abstract
Introduction: Treatment choice in elderly patients (pts) with Diffuse Large B‐Cell Lymphoma (DLBCL) is challenging. A simplified CGA (sCGA) based on ADL (Activity of Daily Living), IADL (Instrumental ADL) and CIRS‐G (Comorbidity Index Rating Scale for Geriatrics) scales has demonstrated to be better than clinical judgement to stratify pts. To confirm the impact of sCGA, we conducted a prospective observational study on the outcome of a large series of elderly pts with DLBCL. Methods: Pts were enrolled if ≥65 years, with an untreated de novo DLBCL. sCGA was available at a web based platform that classified pts as FIT (F), UNFIT (U), and FRAIL (FR), as shown in Table 1. According to anthracycline doses treatment was classified as curative (≥70%), intermediate (<70%) or palliative (no anthracycline). Primary study endpoint was Overall Survival (OS). Results: Form December 2013 to December 2017, 1353 pts have been registered by 37 centres and 1207 were eligible. Median age was 76 years (65‐94), 68% had stage III‐IV, and 55% had an IPI ≥3; 500 (42%), 304 (25%), and 403 (33%) were classified as F, U and FR, respectively. A significant difference among groups was observed in the rate of B symptoms (F 22%, U 27%, FR 31%; p = 0.01), ECOG PS >1 (F 8%, U 15%, FR 38%; p<0.001), anemia (F 34%, U 40%, FR 54%; p<0.001), and IPI ≥3 (F 50%; U 56%; FR 63%; p<0.001). Data on treatment were available in 1164 pts: curative in 89%, 53%, and 36% of F, U, and FR pts, respectively; intermediate in 10%, 39%, and 31%, palliative in <1%, 8%, and 33% of pts. With a median follow up of 29 months (1‐59) 3y‐OS was 64%; according to sCGA the OS was significantly different in the three geriatric groups (Fig. 1). F pts had a significant better 3y‐OS when treated with a curative approach in comparison with intermediate (77% vs 57%, p = 0.003); the use of a curative vs intermediate approach did not affect the outcome of U and FR pts (U: 72% vs 67%, p = 0.257; FR: 63% vs 54%, p = 0.364). The use of palliative approach had a negative impact in all groups. Conclusion: This large prospective observational study on unselected elderly DLBCL pts shows that sCGA is a useful tool to identify three groups of pts with significant different outcome. Our results confirm that curative treatment (R‐CHOP or like) is the standard of care in F pts. In U and FR pts, the intermediate approach improves outcome compared to palliation and is superimposable with curative treatment. FR group warrants further characterization to better define the risk/benefit ratio of treatment.
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