Utility of the frailty score for predicting prognosis and individualizing treatment intensity in elderly patients with diffuse large B cell lymphoma

• Published in: Annals of hematology Vol. 102; no. 6; pp. 1485 - 1500
• Main Authors: Yagi, Yu, Kanemasa, Yusuke, Sasaki, Yuki, Goto, Sotaro, Yamamura, Yasuhiko, Ishimine, Kento, Hayashi, Yudai, Mino, Mano, Ohigashi, An, Morita, Yuka, Tamura, Taichi, Nakamura, Shohei, Okuya, Toshihiro, Shimoyama, Tatsu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2023; Springer Nature B.V
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Chemotherapy; Cyclophosphamide; Doxorubicin; Frailty; Frailty - diagnosis; Frailty - drug therapy; Hematology; Humans; Lymphoma; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - pathology; Medical prognosis; Medicine; Medicine & Public Health; Oncology; Original Article; Prednisone; Prognosis; Retrospective Studies; Rituximab; Treatment Outcome; Vincristine; Frailty score; Diffuse large B cell lymphoma; Charlson Comorbidity Index; Elderly patients; Geriatric Nutritional Risk Index
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-023-05233-2

The optimal dose intensity of chemotherapy for elderly patients with diffuse large B cell lymphoma (DLBCL) remains controversial because of concerns about adverse events and comorbidities related to the patients’ frailty. This single-center study retrospectively analyzed patients aged ≥ 70 years who were newly diagnosed with DLBCL and received chemotherapy between 2004 and 2022. Survival outcomes and treatment-related mortality (TRM) were stratified according to geriatric assessment variables, and the influence of chemotherapy dose intensity on outcomes was assessed using the frailty score with a Cox hazards model with restricted cubic spline (RCS) in patients aged 70–79 years. In total, 337 patients were included. The frailty score accurately predicted prognosis (5-year overall survival [OS]: 73.1%, 60.2%, and 29.7% in fit, unfit, and frail patients, respectively; P < 0.001) and TRM (5-year TRM: 0%, 5.4%, and 16.8 in fit, unfit, and frail patients, respectively; P < 0.001). Cox regression with RCS demonstrated a linear association between dose intensity and survival outcomes. Initial dose intensity (IDI) and relative dose intensity (RDI) had a significant impact on OS in fit patients. However, IDI and RDI had no significant effect on survival in non-fit (unfit and frail) patients. The frailty score identified non-fit patients with poorer survival and a higher risk of TRM. While fit patients were likely to benefit from full-dose R-CHOP, unfit and frail patients would likely benefit more from attenuated R-CHOP. This study suggested a potential role for the frailty score in individualizing treatment intensity in elderly patients with DLBCL.