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Global Risk Indicator and Therapy for Older Patients With Diffuse Large B-Cell Lymphoma: A Population-Based Study
Mengyang Di1,2, Tamra Keeney3,4,5, Emmanuelle Belanger3,4
1Department of Medicine, Alpert Medical School of Brown University, Providence, RI.
JCO Oncology Practice
|November 30, 2021
Summary
Global risk assessment in older adults with diffuse large B-cell lymphoma impacts treatment and outcomes. High-risk patients receive less chemotherapy and face worse survival, highlighting the need for better patient selection.
Area of Science:
- Geriatric Oncology
- Hematologic Malignancies
- Health Services Research
Background:
- Older adults with diffuse large B-cell lymphoma (DLBCL) present unique challenges in treatment selection and outcome prediction.
- A comprehensive 'global risk' assessment, incorporating age, comorbidities, function, and cognition, is crucial for this population.
Purpose of the Study:
- To evaluate the influence of global risk on treatment choices and outcomes for elderly home care recipients diagnosed with DLBCL.
- To identify disparities in care and survival based on global risk stratification.
Main Methods:
- Utilized SEER-Medicare data (2011-2015) for home care recipients with DLBCL and pretreatment OASIS evaluations.
- Developed a global risk indicator (low, moderate, high) based on OASIS assessments.
- Analyzed associations between global risk, chemotherapy receipt, and 30-day post-treatment outcomes (mortality, ED visits, hospitalization, ICU admission) using logistic models.
Main Results:
- Among 1,232 patients (median age 80), 65% received chemotherapy. High-risk patients were less likely to receive any chemotherapy (OR 0.50) or curative regimens (OR 0.59).
- High-risk patients experienced increased 30-day mortality (OR 2.24), ED visits (OR 1.35), hospitalizations (OR 1.60), and ICU admissions (OR 1.52).
- Overall survival was significantly inferior for high-risk patients (HR 1.41).
Conclusions:
- Global risk assessment using OASIS data is readily available and can inform treatment decisions.
- This approach may improve patient selection for curative therapies and guide the implementation of preventive measures for high-risk older adults with DLBCL.
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