Simplified Geriatric Assessment in Older Patients With Diffuse Large B-Cell Lymphoma: The Prospective Elderly Project of the Fondazione Italiana Linfomi
Francesco Merli, Stefano Luminari, Alessandra Tucci, Annalisa Arcari, Luigi Rigacci, Eliza Hawkes, Carlos S Chiattone, Federica Cavallo, Giuseppina Cabras, Isabel Alvarez, Alberto Fabbri, Alessandro Re, Benedetta Puccini, Allison Barraclough, Marcia Torresan Delamain, Simone Ferrero, Sara Veronica Usai, Angela Ferrari, Emanuele Cencini, Elsa Pennese, Vittorio Ruggero Zilioli, Dario Marino, Monica Balzarotti, Maria Christina Cox, Manuela Zanni, Alice Di Rocco, Arben Lleshi, Barbara Botto, Stefan Hohaus, Michele Merli, Roberto Sartori, Guido Gini, Luca Nassi, Gerardo Musuraca, Monica Tani, Chiara Bottelli, Sofia Kovalchuk, Francesca Re, Leonardo Flenghi, Annalia Molinari, Giuseppe Tarantini, Emanuela Chimienti, Luigi Marcheselli, Caterina Mammi, Michele Spina, Francesco Merli, Stefano Luminari, Alessandra Tucci, Annalisa Arcari, Luigi Rigacci, Eliza Hawkes, Carlos S Chiattone, Federica Cavallo, Giuseppina Cabras, Isabel Alvarez, Alberto Fabbri, Alessandro Re, Benedetta Puccini, Allison Barraclough, Marcia Torresan Delamain, Simone Ferrero, Sara Veronica Usai, Angela Ferrari, Emanuele Cencini, Elsa Pennese, Vittorio Ruggero Zilioli, Dario Marino, Monica Balzarotti, Maria Christina Cox, Manuela Zanni, Alice Di Rocco, Arben Lleshi, Barbara Botto, Stefan Hohaus, Michele Merli, Roberto Sartori, Guido Gini, Luca Nassi, Gerardo Musuraca, Monica Tani, Chiara Bottelli, Sofia Kovalchuk, Francesca Re, Leonardo Flenghi, Annalia Molinari, Giuseppe Tarantini, Emanuela Chimienti, Luigi Marcheselli, Caterina Mammi, Michele Spina
Abstract
Purpose: To prospectively validate the use of a simplified geriatric assessment (sGA) at diagnosis and to integrate it into a prognostic score for older patients with diffuse large B-cell lymphoma (DLBCL).
Methods: We conducted the prospective Elderly Project study on patients with DLBCL older than 64 years who underwent our Fondazione Italiana Linfomi original geriatric assessment (oGA) (age, Cumulative Illness Rating Scale for Geriatrics, activities of daily living, and instrumental activities of daily living) before treatment. Treatment choice was left to the physician's discretion. The primary end point was overall survival (OS) (ClinicalTrials.gov identifier: NCT02364050).
Results: We analyzed 1,163 patients (median age 76 years), with a 3-year OS of 65% (95% CI, 62 to 68). Because at multivariate analysis on oGA, age > 80 years retained an independent correlation with OS, we also developed a new, simplified version of the GA (sGA) that classifies patients as fit (55%), unfit (28%), and frail (18%) with significantly different 3-year OS of 75%, 58%, and 43%, respectively. The sGA groups, International Prognostic Index, and hemoglobin levels were independent predictors of OS and were used to build the Elderly Prognostic Index (EPI). Three risk groups were identified: low (23%), intermediate (48%), and high (29%), with an estimated 3-year OS of 87% (95% CI, 81 to 91), 69% (95% CI, 63 to 73), and 42% (95% CI, 36 to 49), respectively. The EPI was validated using an independent external series of 328 cases.
Conclusion: The Elderly Project validates sGA as an objective tool to assess fitness status and defines the new EPI to predict OS of older patients with DLBCL.
Conflict of interest statement
Francesco MerliConsulting or Advisory Role: Janssen, Gilead Sciences, MSD, Takeda, RocheTravel, Accommodations, Expenses: Janssen, Gilead Sciences, EUSA Pharma, Celgene, Roche, Takeda Stefano LuminariConsulting or Advisory Role: Roche, Gilead Sciences, CelgeneTravel, Accommodations, Expenses: Janssen, Celgene Alessandra TucciConsulting or Advisory Role: Janssen, TakedaTravel, Accommodations, Expenses: Sandoz Annalisa ArcariConsulting or Advisory Role: Janssen-CilagTravel, Accommodations, Expenses: Janssen-Cilag, Takeda Luigi RigacciConsulting or Advisory Role: Roche, Gilead Sciences, Takeda, Janssen-Cilag, AbbVie, Celgene/Bristol-Myers Squibb, Merck, MenariniSpeakers' Bureau: Roche, Gilead Sciences, CelgeneTravel, Accommodations, Expenses: Takeda Eliza HawkesConsulting or Advisory Role: Merck Sharpe & Dohme, Roche/Genentech, AstraZeneca, Gilead SciencesSpeakers' Bureau: Roche/GenentechResearch Funding: AstraZeneca, Celgene, Merck KGaA, Janssen-Cilag, Gilead Sciences, Mundipharma, Bristol-Myers SquibbTravel, Accommodations, Expenses: Roche/Genentech Carlos S. ChiattoneConsulting or Advisory Role: Roche, Takeda, Janssen Federica CavalloHonoraria: Takeda, Janssen-Cilag, Gilead SciencesConsulting or Advisory Role: Janssen-Cilag, Gilead SciencesTravel, Accommodations, Expenses: Celgene Alberto FabbriHonoraria: Takeda, Servier/PfizerTravel, Accommodations, Expenses: Takeda Allison BarracloughTravel, Accommodations, Expenses: Roche Simone FerreroConsulting or Advisory Role: Janssen-Cilag, EUSA Pharma, Clinigen GroupSpeakers' Bureau: Janssen-Cilag, Servier, EUSA Pharma, Gilead SciencesTravel, Accommodations, Expenses: Roche, Servier, Sanofi, Janssen-Cilag, EUSA Pharma, Gentili Alice Di RoccoSpeakers' Bureau: Roche/GenentechTravel, Accommodations, Expenses: Roche, Novartis Stefan HohausConsulting or Advisory Role: MSD, EusaPharma, Servier, GentiliniTravel, Accommodations, Expenses: Roche Luca NassiEmployment: SanofiStock and Other Ownership Interests: Sanofi, MolMedConsulting or Advisory Role: Takeda Gerardo MusuracaConsulting or Advisory Role: Janssen Oncology, Servier Leonardo FlenghiTravel, Accommodations, Expenses: Roche, Janssen Michele SpinaEmployment: Bristol-Myers Squibb/Medarex, SanofiConsulting or Advisory Role: Gilead Sciences, IncyteNo other potential conflicts of interest were reported.
Source: PubMed