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Original Article
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A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy
Article first published online: 26 JUN 2009
DOI: 10.1002/cncr.24490
Copyright © 2009 American Cancer Society
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How to Cite
Tucci, A., Ferrari, S., Bottelli, C., Borlenghi, E., Drera, M. and Rossi, G. (2009), A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy. Cancer, 115: 4547–4553. doi: 10.1002/cncr.24490
Publication History
- Issue published online: 17 SEP 2009
- Article first published online: 26 JUN 2009
- Manuscript Accepted: 28 JAN 2009
- Manuscript Revised: 30 DEC 2008
- Manuscript Received: 6 OCT 2008
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Keywords:
- anthracycline;
- comprehensive geriatric assessment;
- diffuse large cell lymphoma;
- elderly patients
By applying a comprehensive geriatric assessment (CGA) to elderly patients with diffuse large cell lymphoma (DLCL) independently from treatment given, the authors identified a cohort of “fit” patients who could tolerate an anthracycline-based treatment and achieve an outcome similar to that of younger patients affected by DLCL. Patients classified as “unfit” according to CGA had a poorer outcome, despite receiving intensive treatment with curative intent or palliation only.
Abstract
BACKGROUND:
The authors set out to analyze if a simple comprehensive geriatric assessment (CGA) could objectively identify elderly patients with diffuse large cell lymphoma (DLCL) who can be effectively treated with anthracycline-containing immunochemotherapy.
METHODS:
CGA was performed in 84 consecutive patients with DLCL aged >65 years and diagnosed at a single institution. Treatment with curative versus palliative intent was chosen according to clinical judgment. Cyclophosphamide, hydroxydaunomycin, Oncovin (vincristine), and prednisone (CHOP) or CHOP-like regimens were given to 62 (74%) patients. The outcome of patients was analyzed according to both the treatment received and the results of CGA.
RESULTS:
According to CGA, 42 (50%) patients were classified as “fit.” They were younger (P < .0001) and had less frequent systemic symptoms (P = .03). These patients received curative treatment by clinical judgment. Their response rate (92.5% vs 48.8%; P < .0001) and median survival (not reached vs 8 months; P < .0001) were significantly better than those of 42 patients considered “unfit” by CGA. Among unfit patients, 20 had actually received curative and 22 palliative therapy. These subgroups did not differ in any geriatric or lymphoma-related characteristic. Their outcome was similar irrespectively of the type of treatment received (median survival, 8 vs 7 months; P = nonsignificant). Lymphoma rather than toxicity was the main cause of failure/death also among unfit patients treated aggressively.
CONCLUSIONS:
CGA is an efficient method to identify elderly DLCL patients who can benefit from a curative approach with anthracycline-containing immunochemotherapy. Further study is needed to discern why unfit patients seem to have poor outcomes because of poor tolerance but also because of lymphoma refractoriness to intensive therapy. Cancer 2009. © 2009 American Cancer Society.