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- Title
Treatment Individualization in Diffuse Large B-Cell Lymphoma: Is Frailty Enough for Old Adults? An Original Article.
- Authors
Garcia-Baztan, Agurne; Oteiza-Olaso, Julio; Gonzales-Montejo, Nancy Jeanette; Ramôn-Espinoza, Maria Fernanda; Tamayo-Rodriguez, Ibai; Martinez-Velilla, Nicolas; Viguria-Alegria, Mari Cruz
- Abstract
Individualized treatment allocation based in previous toxicity risk is recommended in old adults diagnosed with hematologic malignancies. In our study we implemented a hypothetical treatment algorithm in 31 patients aged 70 years and recently diagnosed with diffuse large B-cell lymphoma based on information obtained in a comprehensive geriatric assessment at baseline. We observed that frailty assessment and physical performance evaluation measured by the functional score Short Physical Performance Battery are validated predictive factors suitable for risk stratification. Introduction: Toxicity risk evaluation based on frailty assessment is recommended for treatment individualization in old adults with diffuse large B-cell lymphoma (DLBCL). However, no specific assessment method to guide decision-making has been established yet. Here, we implement a therapeutic algorithm based on the information obtained in an updated comprehensive ger i atr i c assessment (CGA) to assess the value that other prognostic factors add to frailty. Material and Methods: We prospectively recruited 31 patients aged 70 or older recently diagnosed with DLBCL. Standard dose regimen R-CHOP and dose-attenuated R-miniCHOP were the therapeutic options. A CGA-based algorithm was used for the initial treatment recommendation. The sample was compared according to frailty and treatment allocation to describe baseline differential characteristics and treatment tolerance. Results: Mean age was 79 (SD: 5.5) and 45.1% were above 80. Half of the patients (51.6%) were frail; their survival was inferior to that observed in fit adults (p i .034). The mean Short Physical Performance Battery (SPPB) score of patients responding to therapy was higher than non-responders media (8.6 vs. 5.9; p i .022). However, when RCHOP was allocated to high functional patients within fit and frail groups, no differences in survival were found compared to R-miniCHOP. The prevalence of toxic events was higher with the standard regimen in fit (p i .054) and frail patients (p: 0.016). Conclusions: The combination of frailty and physical performance assessment in an algorithm is a promising method to guide the decision-making process in old adults with DLBCL. SPPB might complete frailty predictive information on toxicity risk.
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2023, Vol 23, Issue 10, pe348
- ISSN
2152-2650
- Publication type
Article
- DOI
10.1016/j.clml.2023.06.010