The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort study

  • Ho-Young Yhim (Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital) ;
  • Yong Park (Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Jeong-A Kim (Department of Internal Medicine, The Catholic University of Korea, St. Vincent Hospital) ;
  • Ho-Jin Shin (Department of Internal Medicine, Pusan National University Hospital) ;
  • Young Rok Do (Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Joon Ho Moon (Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Min Kyoung Kim (Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine) ;
  • Won Sik Lee (Department of Internal Medicine, Inje University Busan Paik Hospital) ;
  • Dae Sik Kim (Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Myung-Won Lee (Department of Internal Medicine, Chungnam National University College of Medicine) ;
  • Yoon Seok Choi (Department of Internal Medicine, Chungnam National University College of Medicine) ;
  • Seong Hyun Jeong (Department of Hematology-Oncology, Ajou University School of Medicine) ;
  • Kyoung Ha Kim (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Jinhang Kim (Department of Internal Medicine, The Catholic University of Korea, St. Vincent Hospital) ;
  • Chang-Hoon Lee (Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital) ;
  • Ga-Young Song (Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Deok-Hwan Yang (Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Jae-Yong Kwak (Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital)
  • Received : 2023.06.19
  • Accepted : 2023.11.27
  • Published : 2024.05.01
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Abstract

Background/Aims: Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). Methods: This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). Results: The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. Conclusions: This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.

Keywords

Acknowledgement

This study was supported by Fund of Biomedical Research Institute, Jeonbuk National University Hospital, the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea Under Grand HR20C0021, and the Chonnam National University Hwasun Hospital Research Institute of Clinical Medicine under Grant HCRI22009.

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