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Title: Comprehensive geriatric assessment is useful in an elderly Australian population with diffuse large B-cell lymphoma receiving rituximab-chemotherapy combinations.
Austin Authors: Ong, Doen Ming;Ashby, Michael;Grigg, Andrew P ;Gard, Grace;Ng, Zi Y;Huang, Huayi Ellen;Chong, Yee Shuen;Cheah, Chan Yoon;Devitt, Bianca;Chong, Geoffrey ;Loh, Zoe ;Mo, Allison ;Hawkes, Eliza A 
Affiliation: Department of Haematology, Austin Health, Heidelberg, Victoria, Australia
Department of Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Australia
Medical School, University of Western Australia, Crawley, Australia
Department of Oncology, Eastern Health, Melbourne, Australia
Department of Haematology, Eastern Health, Melbourne, Australia
Department of Haematology, Pathwest Laboratory Medicine, Nedlands, Western Australia, Australia
Eastern Health Clinical School, Monash University, Melbourne, Australia
Issue Date: Oct-2019 2019-06-17
Publication information: British journal of haematology 2019; 187(1): 73-81
Abstract: Elderly patients may be heterogeneous in their abilities to tolerate immunochemotherapy-associated toxicities. We describe the morbidity of rituximab-chemotherapy combinations among 205 newly-diagnosed diffuse large B-cell lymphoma (DLBCL) patients aged ≥60 years from 3 tertiary hospitals between 2009 and 2016, and explore the utility of retrospectively-assigned baseline Comprehensive Geriatric Assessment (CGA) in predicting these toxicities. Seventy-three percent (146/201) experienced grade ≥3 toxicities, 81% (163/201) needed admission, 52% (107/205) had ≥2 unplanned admissions, 82/201 (41%) required dose reductions (DR) subsequent to Cycle 1, 39/166 (23%) had chemotherapy delays and 26/198 (13%) ceased therapy early. CGA was associated with pre-emptive baseline DR and perhaps because of this, did not predict grade ≥3 toxicities, ≥2 unplanned admissions or subsequent DR. Three-year overall survival (OS) of CGA-fit, CGA-unfit and CGA-frail patients was 82%, 60% and 53%, respectively. Three-year progression-free survival (PFS) of CGA-fit, CGA-unfit and CGA-frail patients was 66%, 58% and 46%, respectively. OS of CGA-fit patients was not statistically different from CGA-unfit patients, but was superior to CGA-frail patients (hazard ratio 2·892, 95% confidence interval 1·275-6·559, P = 0·011). PFS differences were not statistically significant. Baseline DR and early therapy cessation were associated with inferior OS and PFS independent of CGA. Prospective studies are needed to confirm if CGA-adapted treatment strategies minimize morbidity and improves survival.
DOI: 10.1111/bjh.16049
ORCID: 0000-0003-4097-8583
Journal: British journal of haematology
PubMed URL: 31206608
Type: Journal Article
Subjects: DLBCL
Geriatric assessment
Appears in Collections:Journal articles

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