Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort studyopen access
- Authors
- Yhim, Ho-Young; Park, Yong; Kim, Jeong-A; Shin, Ho-Jin; Do, Young Rok; Moon, Joon Ho; Kim, Min Kyoung; Lee, Won Sik; Kim, Dae Sik; Lee, Myung-Won; Choi, Yoon Seok; Jeong, Seong Hyun; Kim, Kyoung Ha; Kim, Jinhang; Lee, Chang-Hoon; Song, Ga-Young; Yang, Deok-Hwan; Kwak, Jae-Yong
- Issue Date
- Jan-2024
- Publisher
- KOREAN ASSOC INTERNAL MEDICINE
- Keywords
- Diffuse large B-cell lymphoma; Simplified geriatric assessment; Prognosis; Dose intensity; Toxicity
- Citation
- KOREAN JOURNAL OF INTERNAL MEDICINE, v.39, no.3, pp 501 - 512
- Pages
- 12
- Journal Title
- KOREAN JOURNAL OF INTERNAL MEDICINE
- Volume
- 39
- Number
- 3
- Start Page
- 501
- End Page
- 512
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/26185
- DOI
- 10.3904/kjim.2023.265
- ISSN
- 1226-3303
2005-6648
- 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, p < 0.001; fit vs. frail, HR 4.61, p < 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, p = 0.002). It was related with a higher incidence of grade >= 3 symptomatic non -hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 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.
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