A novel comorbidity score for older adults with non-Hodgkin lymphoma: the 3-factor risk estimate scale

Blood Advances - Tập 7 - Trang 2632-2642 - 2023
Max J. Gordon1, Zhigang Duan2, Hui Zhao2, Loretta Nastoupil3, Alessandra Ferrajoli4, Alexey V. Danilov5, Sharon H. Giordano2
1Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
2Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
3Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
4Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
5Department of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA

Tóm tắt

Abstract

For patients with non-Hodgkin lymphoma (NHL), formal comorbidity assessment is recommended but is rarely conducted in routine practice. A simple, validated measure of comorbidities that standardizes their assessment could improve adherence to guidelines. We previously constructed the 3-factor risk estimate scale (TRES) among patients with chronic lymphocytic leukemia (CLL). Here, we investigated TRES in multiple NHL subtypes. In the surveillance, epidemiology, and end results–Medicare database, patients with NHL diagnosed from 2008 to 2017 were included. Upper gastrointestinal, endocrine, and vascular comorbidities were identified using ICD-9/ICD-10 codes to assign TRES scores. Patient characteristic distributions were compared using χ2 or t test. Association of mortality and TRES score was assessed using Kaplan-Meier and multivariable Cox regression model for competing risk. A total of 40 486 patients were included in the study. Median age was 77 years (interquartile range [IQR], 71-83 years). The most frequent NHL subtypes were CLL (28.2%), diffuse large B-cell (27.6%), and follicular lymphoma (12.6%). Median follow-up was 33 months (IQR, 13-60 months). TRES was low, intermediate, and high in 40.8%, 37.0%, and 22.2% of patients, corresponding to median overall survival (OS) of 8.2, 5.3, and 2.9 years (P < .001), respectively. TRES was associated with OS in all NHL subtypes. In multivariable models, TRES was associated with inferior OS and NHL-specific survival. TRES is clinically translatable and associated with OS and lymphoma-specific survival in older adults with NHL.


Tài liệu tham khảo

Siegel, 2015, Cancer statistics, 2015, CA Cancer J Clin, 65, 5, 10.3322/caac.21254 Gordon, 2018, Comorbidities predict inferior outcomes in chronic lymphocytic leukemia treated with ibrutinib, Cancer, 124, 3192, 10.1002/cncr.31554 Gordon, 2021, Medical comorbidities in patients with chronic lymphocytic leukaemia treated with idelalisib: analysis of two large randomised clinical trials, Br J Haematol, 192, 720, 10.1111/bjh.16879 Goede, 2016, Evaluation of geriatric assessment in patients with chronic lymphocytic leukemia: results of the CLL9 trial of the German CLL study group, Leuk Lymphoma, 57, 789, 10.3109/10428194.2015.1091933 Isaksen, 2021, A simplified frailty score predicts survival and can aid treatment-intensity decisions in older patients with DLBCL, Blood Adv, 5, 4771, 10.1182/bloodadvances.2021004777 Rotbain, 2021, Mapping comorbidity in chronic lymphocytic leukemia: impact of individual comorbidities on treatment, mortality, and causes of death, Leukemia, 35, 2570, 10.1038/s41375-021-01156-x Sorror, 2005, Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT, Blood, 106, 2912, 10.1182/blood-2005-05-2004 Merli, 2021, Simplified geriatric assessment in older patients with diffuse large B-cell lymphoma: the prospective elderly project of the fondazione italiana linfomi, J Clin Oncol, 39, 1214, 10.1200/JCO.20.02465 NCCN Guidelines . B-Cell Lymphomas, version 5.2002. Accessed 11 April 2022. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1480. NCCN Guidelines . T-Cell Lymphomas, version 2.2022. Accessed 11 April 2022. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1483. Thurmes, 2008, Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia, Leuk Lymphoma, 49, 49, 10.1080/10428190701724785 Kittai, 2021, Comorbidities predict inferior survival in patients receiving chimeric antigen receptor T-cell therapy for diffuse large B-cell lymphoma: a multicenter analysis, Biol Blood Marrow Transplant, 27, 46 Hallek, 2018, iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL, Blood, 131, 2745, 10.1182/blood-2017-09-806398 NCCN Version 1.2023, Chronic lymphocytic leukemia/small lymphocytic lymphoma guidelines. 2022. Accessed 11 April 2022. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1478. Salvi, 2008, A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients, J Am Geriatr Soc, 56, 1926, 10.1111/j.1532-5415.2008.01935.x Gordon, 2021, The chronic lymphocytic leukemia comorbidity index (CLL-CI): a three-factor comorbidity model, Clin Cancer Res, 27, 4814, 10.1158/1078-0432.CCR-20-3993 Rotbain, 2022, The CLL comorbidity index in a population-based cohort: a tool for clinical care and research, Blood Adv, 6, 2701, 10.1182/bloodadvances.2021005716 Tanaka, 2022, Comprehensive geriatric assessment as a useful tool in predicting adverse events in elderly patients with diffuse large B-cell lymphoma, Sci Rep, 12, 3124, 10.1038/s41598-022-07164-w Enewold, 2020, Updated overview of the SEER-Medicare data: enhanced content and applications, J Natl Cancer Inst Monogr, 2020, 3 Institute NC . SEER-Medicare: brief description of the SEER-Medicare database. Published 2022. Accessed 11 April 2022. https://healthcaredelivery.cancer.gov/seermedicare/overview/. Chesnaye, 2022, An introduction to inverse probability of treatment weighting in observational research, Clin Kidney J, 15, 14, 10.1093/ckj/sfab158 Austin, 2015, Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies, Stat Med, 34, 3661, 10.1002/sim.6607 Tedeschi, 2020, Do age, fitness and concomitant medications influence management and outcomes of CLL patients treated with ibrutinib?, Blood, 136, 54, 10.1182/blood-2020-137024 Strati, 2017, Relationship between co-morbidities at diagnosis, survival and ultimate cause of death in patients with chronic lymphocytic leukaemia (CLL): a prospective cohort study, Br J Haematol, 178, 394, 10.1111/bjh.14785 Wästerlid, 2019, Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B-cell lymphoma: a Swedish lymphoma register study, J Intern Med, 285, 455, 10.1111/joim.12849 Charlson, 1987, A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation, J Chron Dis, 40, 373, 10.1016/0021-9681(87)90171-8 Gordon, 2022 Neelapu, 2022, Axicabtagene ciloleucel as first-line therapy in high-risk large B-cell lymphoma: the phase 2 ZUMA-12 trial, Nat Med, 28, 735, 10.1038/s41591-022-01731-4 Tilly, 2022, Polatuzumab vedotin in previously untreated diffuse large B-cell lymphoma, N Engl J Med, 386, 351, 10.1056/NEJMoa2115304 Sehn, 2007, The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP, Blood, 109, 1857, 10.1182/blood-2006-08-038257 International CLL-IPI working group, 2016, An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data, Lancet Oncol, 17, 779, 10.1016/S1470-2045(16)30029-8 Solal-Céligny, 2004, Follicular lymphoma international prognostic index, Blood, 104, 1258, 10.1182/blood-2003-12-4434 Sheng, 2022, Association of the CLL comorbidity index (CLL-CI) and international prognostic index (IPI) with overall survival (OS) and 1-year mortality in patients (pts) with relapsed or refractory (r/r) large B cell lymphoma (LBCL) treated with CD19 directed autologous chimeric antigen receptor T (CART) cell therapies, Blood, 140, 2051, 10.1182/blood-2022-165398
Thông tin
Thông tin xuất bản

Blood Advances

Tập 7

2632-2642

Thông tin tác giả