The elderly prognostic index predicts early mortality in older patients with diffuse large B-cell lymphoma. An ad hoc analysis of the elderly project by the Fondazione Italiana Linfomi

被引：7

作者：

Cencini, Emanuele ^{[1
,2
]}

Tucci, Alessandra ^{[3
]}

Puccini, Benedetta ^{[4
,5
]}

Cavallo, Federica ^{[6
]}

Luminari, Stefano ^{[7
,8
]}

Usai, Sara Veronica ^{[9
]}

Fabbri, Alberto ^{[1
,2
]}

Pennese, Elsa ^{[10
]}

Marino, Dario ^{[11
]}

Zilioli, Vittorio Ruggero ^{[12
]}

Balzarotti, Monica ^{[13
]}

Petrucci, Luigi ^{[14
]}

Tafuri, Agostino ^{[15
]}

Arcari, Annalisa ^{[16
]}

Botto, Barbara ^{[17
]}

Zanni, Manuela ^{[18
]}

Hohaus, Stefan ^{[19
]}

Sartori, Roberto ^{[20
]}

Merli, Michele ^{[21
,22
]}

Gini, Guido ^{[23
]}

Al Essa, Wael ^{[24
,25
]}

Musurca, Gerardo ^{[26
]}

Tani, Monica ^{[27
]}

Nassi, Luca ^{[4
,5
]}

Daffini, Rosa ^{[3
]}

Mammi, Caterina ^{[28
]}

Marcheselli, Luigi ^{[29
]}

Bocchia, Monica ^{[1
,2
]}

Spina, Michele ^{[30
]}

Merli, Francesco ^{[7
]}

机构：

[1] Azienda Osped Univ Senese, Unit Hematol, Siena, Italy

[2] Univ Siena, Siena, Italy

[3] ASST Spedali Civili Brescia, Hematol Div, Brescia, Italy

[4] Careggi Hosp, Hematol Dept, Florence, Italy

[5] Univ Florence, Florence, Italy

[6] Univ Torino, Dept Mol Biotechnol & Hlth Sci, Div Hematol, AOU Citta Salute & Sci Torino, Turin, Italy

[7] Azienda USL IRCCS Reggio Emilia, Hematol, Reggio Emilia, Italy

[8] Univ Modena & Reggio Emilia, Dept CHIMOMO, Reggio Emilia, Italy

[9] Osped Oncol Armando Businco, Div Hematol, Cagliari, Italy

[10] Osped Spirito Santo, Lymphoma Unit, Dept Hematol, Pescara, Italy

[11] Veneto Inst Oncol IOV IRCCS, Oncol Unit 1, Padua, Italy

[12] ASST Grande Osped Metropolitano Niguarda, Div Hematol, Milan, Italy

[13] IRCCS Humanitas Res Hosp, Dept Med Oncol & Hematol, Milan, Italy

[14] Univ Roma, Dept Tanslat & Precis Med La Sapienza, Inst Hematol, Rome, Italy

[15] Univ Hosp S Andrea Sapienza, Hematol, Rome, Italy

[16] Osped Guglielmo Saliceto, Hematol Unit, Piacenza, Italy

[17] Citta Salute & Sci Hosp & Univ, Div Hematol, Turin, Italy

[18] Antonio & Biagio & Cesare Arrigo Hosp, Hematol Unit, Alessandria, Italy

[19] Univ Cattolica Sacro Cuore, Univ Policlin Gemelli Fdn IRCCS, Rome, Italy

[20] IOV IRCCS, Veneto Inst Oncol, Oncohematol Unit, Padua, Italy

[21] Univ Insubria, Osped Circolo, Div Hematol, Varese, Italy

[22] Univ Insubria, Fdn Macchi ASST Sette Laghi, Varese, Italy

[23] Univ Politecn Marche, Clin Hematol AOU Osped Riuniti Ancona, Ancona, Italy

[24] Amedeo Avogadro Univ Eastern Piedmont, Dept Translat Med, Div Hematol, Novara, Italy

[25] Azienda Osped Univ Maggiore Carita Novara, Novara, Italy

[26] IRCCS Ist Romagnolo Studio Tumori IRST Dino Amado, Hematol Unit, Meldola, Italy

[27] Santa Maria Croci Hosp, Hematol Unit, Ravenna, Italy

[28] Grp Amici Ematol Grade Onlus Fdn, Reggio Emilia, Italy

[29] Fdn Italiana Linfomi Onlus, Modena, Italy

[30] IRCCS, Ctr Riferimento Oncol Aviano CRO, Div Med Oncol & Immunerelated Tumors, Aviano, Italy

来源：

HEMATOLOGICAL ONCOLOGY | 2023年 / 41卷 / 01期

关键词：

diffuse large B-cell lymphoma; early mortality; elderly prognostic index; geriatric assessment; survival; COMPREHENSIVE GERIATRIC ASSESSMENT; MOLECULAR CHARACTERISTICS; TREATMENT DECISIONS; CHOP CHEMOTHERAPY; RITUXIMAB-CHOP; TRIAL; AGE; IMMUNOCHEMOTHERAPY; CYCLOPHOSPHAMIDE; MULTICENTER;

D O I：

10.1002/hon.3081

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

The Elderly Prognostic Index (EPI) is based on the integration of a simplified geriatric assessment, hemoglobin levels and International Prognostic Index and has been validated to predict overall survival in older patients with diffuse large B-cell lymphoma (DLBCL). In this study, we evaluated the ability of EPI to predict the risk of early mortality. This study included all patients registered in the Elderly Project for whom treatment details and a minimum follow-up of 3 months were available. Three main treatment groups were identified based on the anthracycline amount administered: cases receiving >70% of the theoretical anthracyclines dose (Full Dose [FD] group), <= 70% (Reduced Dose [RD]) and palliative therapy (PT; no anthracyclines). The primary endpoint was early mortality rate, defined as death for any cause occurring within 90 days from diagnosis. We identified 1150 patients with a median age of 76 years (range 65-94). Overall, 69 early deaths were observed, accounting for 19% of all reported deaths. The cumulative rate of early mortality at 90 days was 6.0%. Comparing early with delayed deaths, we observed a lower frequency of deaths due to lymphoma progression (42% vs. 75%; p < 0.001) and a higher frequency due to toxicity and infections (22% vs. 4%, p < 0.001, and 22% vs. 3%, p < 0.001, respectively) for early events. A multivariable logistic analysis on 931 patients (excluding PT) confirmed an independent association of high-risk EPI (odds ratio [OR] 3.60; 95% confidence interval [CI] 1.15-11.2) and bulky disease (OR 2.08; 95% CI 1.09-3.97) with the risk of early mortality. The cumulative incidence of early mortality for older patients with DLBCL is not negligible and is mainly associated with non-lymphoma related events. For patients receiving anthracyclines, high-risk EPI and bulky disease are associated with a higher probability of early mortality.

引用

页码：78 / 87

页数：10

共 43 条

[1] Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone is beneficial but toxic in very elderly patients with diffuse large B-cell lymphoma: a population-based cohort study on treatment, toxicity and outcome [J].