Value of comprehensive geriatric assessment in treatment for elderly
patients with diffuse large B cell lymphoma

doi:10.3760/cma.j.issn.1007-1245.2022.03.021

Abstract

Abstract:

Objective　To explore the value of comprehensive geriatric assessment (CGA) in treatment for elderly patients with diffuse large B cell lymphoma (DLBCL). Methods　Seventy ≥65 years old patients with DLBCL treated at Department of Oncology and Hematology, Songjiang District Central Hospital from January 2015 to December 2017 were enrolled in the study, and were divided into a fit group, an unfit group, and a frail group according to the CGA criteria. The correlations of the clinical characteristics with the treatment efficacy, prognosis, and adverse reactions in the three groups were analyzed. Chi-square test, Fisher's exact test, and rank sum test were applied. The Kaplan-Meier was used for survival analysis. The log-rank test was used for the comparison between curves. Results　There were 70 patients, including 39 males and 31 females, with a median age of 69 (65-89). According to the CAG criteria, there were 35 (50.0%, 35/70) in the fit group, 13 (18.6%, 13/70) in the unfit group, and 22 (31.4%, 22/70) in the frail group. The patients had worse physical status (ECOG score) and more patients had intermediate-high/high IPI risk class in the frail group than in the fit group and the unfit group, with statistical differences (χ²=38.859 and 13.638, both P<0.01). The overall response rate of chemotherapy was 100.0% (35/35) in the fit group, 100.0% (13/13) in the unfit group, and 36.4% (8/22) in the frail group, with a statistical difference (χ²=38.182,P<0.01). There were no statistical differences in the incidences of hematological and non-hematologic adverse reactions of grade≥3 between the 3 groups. The 2-year follow up showed that 2-year progression-free survival rates in the fit group, the unfit group, and the frail group were 57.1% (20/35), 46.2% (6/13), and 18.2% (4/22), with a statistical difference (χ²=22.919, P<0.01). In the unfit group, there were no statistical differences in the response rate of chemotherapy and 2-year progression-free survival rate between the patients treated by chemotherapy of a standard dosage and the patients treated by chemotherapy of a low dosage. Conclusion　CGA may be more comprehensive in assessing the physical conditions of elderly patients with DLBCL, can effectively predict the therapeutic effect and prognosis, and provide assistance for guiding therapeutic strategies.

Key words: Elderly, Diffuse large B cell lymphoma, Comprehensive geriatric assessment

摘要： 目的　探讨老年综合评估（CGA）在老年弥漫大B细胞淋巴瘤（DLBCL）治疗中的应用价值。方法　本试验选取2015年１月至2017年12月在上海市松江区中心医院肿瘤血液科治疗的70例年龄≥65岁的DLBCL患者为研究对象，根据CGA标准将患者分为适合组、不适合组和脆弱组。分析3组患者临床资料与治疗疗效、预后和不良反应的相关性。采用卡方、Fisher精确概率法及秩和检验，生存分析采用Kaplan-Meier法，曲线间的比较采用log-rank检验。结果　70例患者，男39例、女31例，中位年龄69岁（65～89岁）。根据CAG分组标准，适合组35例（50.0%，35/70）、不适合组13例（18.6%，13/70）、脆弱组22例（31.4%，22/70）。与适合组、不适合组比较，脆弱组患者体力状况更差（ECOG评分）、淋巴瘤国际预后指数（IPI）评分高中危-高危组患者比例更高，差异有统计学意义（χ²=38.859、13.638，均P<0.01）。适合组、不适合组和脆弱组患者化疗有效率分别为100.0%（35/35）、100.0%（13/13）和36.4%（8/22），差异有统计学意义（χ²=38.182，P<0.01）。在3组患者中，≥3级血液学和非血液学不良反应差异均无统计学意义。随访2年，适合组、不适合组和脆弱组患者2年无进展生存（PFS）率分别为57.1%（20/35）、46.2%（6/13）、18.2%（4/22），差异有统计学意义（χ²=22.919，P<0.01）；在不适合组中，接受标准剂量化疗和低剂量化疗患者的化疗有效率和2年PFS比较，差异均无统计学意义。结论　CGA能更为全面地评估老年DLBCL患者身体状况，能有效预测治疗疗效、预后，对治疗决策有指导意义。

关键词: 老年人, 弥漫大B细胞淋巴瘤, 老年综合评估

Ke Jin, Liu Xiaohui, Wang Hengshi, Zhang Shanlan. Value of comprehensive geriatric assessment in treatment for elderly patients with diffuse large B cell lymphoma[J]. International Medicine and Health Guidance News, 2022, 28(3): 385-389.

柯金, 刘晓辉, 王恒石, 张善兰. 老年综合评估在老年弥漫大B细胞淋巴瘤治疗中的价值[J]. 国际医药卫生导报, 2022, 28(3): 385-389.

References

[1] 中华医学会血液学分会,中国抗癌协会淋巴瘤专业委员会. 中国弥漫大B细胞淋巴瘤诊断与治疗指南(2013年版)[J]. 中华血液学杂志,2013(9). DOI:10.3760/cma.j.issn.0253-2727.2013.09.019.

[2] Thieblemont C, Bernard S, Molina T. Management of aggressive lymphoma in very elderly patients[J]. Hematol Oncol, 2017,35 Suppl 1(Suppl Suppl 1):49-53. DOI: 10.1002/hon.2413.

[3] 中国淋巴瘤病理研究协作组,李小秋,李甘地,等.中国淋巴瘤亚型分布:国内多中心性病例10002例分析[J].诊断学理论与实践,2012,11(2):111-115.DOI:10.3969/j.issn.1671-2870.2012.02.006.

[4] Howlader N, Morton LM, Feuer EJ, et al. Contributions of subtypes of non-hodgkin lymphoma to mortality trends[J]. Cancer Epidemiol Biomarkers Prev, 2016,25(1):174-179. DOI: 10.1158/1055-9965.EPI-15-0921.

[5] Pfreundschuh M.How I treat elderly patients with diffuse large B-cell lymphoma [J].Blood,2010,116 (24):5103-5110.DOI:10.1182/blood-2010-07-259333

[6] Liuu E, Hu C, Valero S, et al. Comprehensive geriatric assessment in older patients with cancer: an external validation of the multidimensional prognostic index in a French prospective cohort study[J]. BMC Geriatr, 2020,20(1):295. DOI: 10.1186/s12877-020-01692-8.

[7] Hernandez Torres C, Hsu T. Comprehensive geriatric assessment in the older adult with cancer: a review[J]. Eur Urol Focus, 2017,3(4-5):330-339. DOI: 10.1016/j.euf.2017.10.010.

[8] 韩惠秀,刘辉.老年综合评估在弥漫大B细胞淋巴瘤中应用的研究[J].中华老年医学杂志,2018,37(8):946-950.DOI:10.3760/cma.j.issn.0254-9026.2018.08.028.

[9] Merli F, Luminari S, Tucci A, et al. The elderly project by the fondazione italiana linfomi (fil): a prospective multidimensional assessment of elderly patients with diffuse large b-cell lymphoma[J]. Blood, 2016, 128(22):3049-3049.DOI: 10.1182/blood.V128.22.3049.3049.

[10] Xue K, Gu JJ, Zhang Q, et al. Cardiotoxicity as indicated by LVEF and troponin T sensitivity following two anthracycline-based regimens in lymphoma: results from a randomized prospective clinical trial[J]. Oncotarget, 2016,7(22):32519-32531. DOI: 10.18632/oncotarget. 8685.

[11] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1):7-30. DOI: 10.3322/caac.21442.

[12] 刘鹏,姜时雨,何小慧,等.老年弥漫大B细胞淋巴瘤患者一线治疗方案疗效比较和预后分析[J].中华肿瘤杂志,2020,42(3):234-241.DOI:10.3760/cma.j.cn112152-20190705- 00413.

[13] Iioka F, Izumi K, Kamoda Y, et al. Outcomes of very elderly patients with aggressive B-cell non-Hodgkin lymphoma treated with reduced-dose chemotherapy[J]. Int J Clin Oncol, 2016,21(3):498-505. DOI: 10.1007/s10147-015- 0912-6.

[14] Chihara D, Westin JR, Oki Y, et al. Management strategies and outcomes for very elderly patients with diffuse large B-cell lymphoma[J]. Cancer, 2016,15;122(20):3145-3151. DOI: 10.1002/cncr.30173.

[15] 文菁菁,刘志彬,徐娟,等.681例弥漫大B细胞淋巴瘤患者的临床特征分析[J].中华血液学杂志,2012,33(12):1004-1009.DOI:10.3760/cma.j.issn.0253-2727.2012. 12.005.

[16] 赵淑清,李军民,徐子真,等.老年弥漫大B细胞淋巴瘤预后的相关影响因素探讨[J].医学临床研究,2017,34(2):219-221,225.DOI:10.3969/j.issn.1671-7171.2017.02.004.

[17] Decoster L, Van Puyvelde K, Mohile S, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations†[J]. Ann Oncol, 2015,26(2):288-300. DOI: 10.1093/annonc/mdu210.

[18] Hamaker ME, Prins MC, Stauder R. The relevance of a geriatric assessment for elderly patients with a haematological malignancy--a systematic review[J]. Leuk Res, 2014,38(3):275-283. DOI: 10.1016/j.leukres. 2013.12.018.

[19] Hamaker ME, Augschoell J, Stauder R. Clinical judgement and geriatric assessment for predicting prognosis and chemotherapy completion in older patients with a hematological malignancy[J]. Leuk Lymphoma, 2016,57(11):2560-2567. DOI: 10.3109/10428194.2016. 1163345.

[20] Tucci A, Ferrari S, Bottelli C, et al. A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy[J]. Cancer, 2009,115(19):4547-4553. DOI: 10.1002/cncr.24490.

[21] Merli F, Luminari S, Rossi G, et al. 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[J]. Leuk Lymphoma, 2014,55(1):38-43. DOI: 10.3109/10428194.2013.788176.

[22] Bai JF, Han HX, Feng R, et al. Comprehensive geriatric assessment (CGA): a simple tool for guiding the treatment of older adults with diffuse large B-cell lymphoma in China[J]. Oncologist, 2020,25(8):e1202-e1208. DOI: 10.1634/theoncologist.2019-0738.

[23] Tucci A, Martelli M, Rigacci L, et al. Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: a prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL)[J]. Leuk Lymphoma, 2015,56(4):921-926. DOI: 10.3109/10428194.2014.953142.

Value of comprehensive geriatric assessment in treatment for elderly patients with diffuse large B cell lymphoma

老年综合评估在老年弥漫大B细胞淋巴瘤治疗中的价值

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 3

Recommended Articles

Metrics

[1]	Li Yufeng. Application effect of butylphthalide soft capsules and idebenone in elderly patients with vascular dementia [J]. International Medicine and Health Guidance News, 2022, 28(4): 471-474.
[2]	Chen Juan, Feng Wenhua, Hou Xiaojun, Cheng Junhua. Effect of kettlebell training on elderly women with sarcopenia [J]. International Medicine and Health Guidance News, 2022, 28(2): 180-184.
[3]	Li Ling , Ding Yuanzhen , Shi Tingqi. Clinical efficacy observation on acupoint intradermal acupuncture combined with Yaotongning capsules in the treatment of elderly patients with chronic low back pain [J]. International Medicine and Health Guidance News, 2022, 28(2): 251-255.