Outcome of frail elderly patients with diffuse large B-cell lymphoma prospectively identified by Comprehensive Geriatric Assessment: Results from a study of the Fondazione Italiana Linfomi

Francesco Merli, Stefano Luminari, Giuseppe Rossi, Caterina Mammi, Luigi Marcheselli, Angela Ferrari, Michele Spina, Alessandra Tucci, Caterina Stelitano, Isabella Capodanno, Alberto Fragasso, Luca Baldini, Chiara Bottelli, Elisa Montechiarello, Stefano Fogazzi, Cinzia Lamorgese, Lara Cavalli, Massimo Federico

Research output: Contribution to journalArticle

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Abstract

In 2003 the Fondazione Italiana Linfomi (FIL) started a clinical research program for investigating initial treatment of frail elderly patients with diffuse large B-cell lymphoma (DLBCL) identified by Comprehensive Geriatric Assessment (CGA). From 2003 to 2006, 334 elderly patients underwent CGA assessment, and 99 patients were classified as frail. Frail patients had a median age of 78 years, stage III-IV disease in 62% and age-adjusted International Prognostic Index (aaIPI) of 2-3 in 53%. Treatment consisted of several different regimens according to physician discretion. After a median follow-up of 36 months, 5-year overall survival (OS) was 28%. In multivariate analysis, aaIPI 2-3 (p = 0.005) and the presence of respiratory comorbidity (p = 0.044) were the only factors that showed independent correlation with OS. Frail patients had a poorer outcome compared with fit patients also if they were treated with rituximab-containing combination chemotherapy (hazard ratio 2.37, 95% confidence interval 1.48-3.78; p <0.001). CGA is a valid tool to prospectively identify frail subjects among elderly patients with DLBCL.

Original languageEnglish
Pages (from-to)38-43
Number of pages6
JournalLeukemia and Lymphoma
Volume55
Issue number1
DOIs
Publication statusPublished - Jan 2014

Fingerprint

Geriatric Assessment
Frail Elderly
Lymphoma, Large B-Cell, Diffuse
Survival
Combination Drug Therapy
Comorbidity
Multivariate Analysis
Confidence Intervals
Physicians
Therapeutics
Research

Keywords

  • Chemotherapy
  • Comprehensive Geriatric Assessment (CGA)
  • Diffuse large B-cell lymphoma (DLBCL)
  • Elderly patients
  • Frail patients
  • Rituximab

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Outcome of frail elderly patients with diffuse large B-cell lymphoma prospectively identified by Comprehensive Geriatric Assessment : Results from a study of the Fondazione Italiana Linfomi. / Merli, Francesco; Luminari, Stefano; Rossi, Giuseppe; Mammi, Caterina; Marcheselli, Luigi; Ferrari, Angela; Spina, Michele; Tucci, Alessandra; Stelitano, Caterina; Capodanno, Isabella; Fragasso, Alberto; Baldini, Luca; Bottelli, Chiara; Montechiarello, Elisa; Fogazzi, Stefano; Lamorgese, Cinzia; Cavalli, Lara; Federico, Massimo.

In: Leukemia and Lymphoma, Vol. 55, No. 1, 01.2014, p. 38-43.

Research output: Contribution to journalArticle

Merli, F, Luminari, S, Rossi, G, Mammi, C, Marcheselli, L, Ferrari, A, Spina, M, Tucci, A, Stelitano, C, Capodanno, I, Fragasso, A, Baldini, L, Bottelli, C, Montechiarello, E, Fogazzi, S, Lamorgese, C, Cavalli, L & Federico, M 2014, 'Outcome of frail elderly patients with diffuse large B-cell lymphoma prospectively identified by Comprehensive Geriatric Assessment: Results from a study of the Fondazione Italiana Linfomi', Leukemia and Lymphoma, vol. 55, no. 1, pp. 38-43. https://doi.org/10.3109/10428194.2013.788176
Merli, Francesco ; Luminari, Stefano ; Rossi, Giuseppe ; Mammi, Caterina ; Marcheselli, Luigi ; Ferrari, Angela ; Spina, Michele ; Tucci, Alessandra ; Stelitano, Caterina ; Capodanno, Isabella ; Fragasso, Alberto ; Baldini, Luca ; Bottelli, Chiara ; Montechiarello, Elisa ; Fogazzi, Stefano ; Lamorgese, Cinzia ; Cavalli, Lara ; Federico, Massimo. / Outcome of frail elderly patients with diffuse large B-cell lymphoma prospectively identified by Comprehensive Geriatric Assessment : Results from a study of the Fondazione Italiana Linfomi. In: Leukemia and Lymphoma. 2014 ; Vol. 55, No. 1. pp. 38-43.
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abstract = "In 2003 the Fondazione Italiana Linfomi (FIL) started a clinical research program for investigating initial treatment of frail elderly patients with diffuse large B-cell lymphoma (DLBCL) identified by Comprehensive Geriatric Assessment (CGA). From 2003 to 2006, 334 elderly patients underwent CGA assessment, and 99 patients were classified as frail. Frail patients had a median age of 78 years, stage III-IV disease in 62{\%} and age-adjusted International Prognostic Index (aaIPI) of 2-3 in 53{\%}. Treatment consisted of several different regimens according to physician discretion. After a median follow-up of 36 months, 5-year overall survival (OS) was 28{\%}. In multivariate analysis, aaIPI 2-3 (p = 0.005) and the presence of respiratory comorbidity (p = 0.044) were the only factors that showed independent correlation with OS. Frail patients had a poorer outcome compared with fit patients also if they were treated with rituximab-containing combination chemotherapy (hazard ratio 2.37, 95{\%} confidence interval 1.48-3.78; p <0.001). CGA is a valid tool to prospectively identify frail subjects among elderly patients with DLBCL.",
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