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Relative Dose Intensity and Survival Outcomes in Older Adults With Lymphoma: A Single-Center Retrospective Analysis
Akira Mochizuki1, Shotaro Hagiwara2,3,4
1Department of Hospital Pharmacy Mito Kyodo General Hospital Mito Japan.
Background:
Treatment intensity in older adults with lymphoma is often reduced because of frailty, comorbidities, and poor performance status (PS). Whether chronological age or delivered treatment intensity better predicts outcomes remains unclear.
Methods:
We retrospectively reviewed 79 patients aged ≥ 65 years with newly diagnosed lymphoma initiating first-line therapy. Progression-free survival (PFS) was the primary outcome and overall survival (OS) secondary. Relative dose intensity (RDI) effects were expressed as hazard ratios (HRs) per 10%-point increase. Cox models adjusted for age, sex, Ann Arbor stage, Charlson Comorbidity Index (CCI), and PS; diffuse large B-cell lymphoma (DLBCL) models additionally included the International Prognostic Index (IPI).
Results:
Median RDI was lower in patients aged ≥ 75 years than in those aged 65-74 years (63.3% vs. 85.4%; p < 0.001). In the full cohort, higher RDI was independently associated with longer PFS (HR, 0.709; 95% CI, 0.576-0.873; p = 0.001), but not OS (HR, 0.814; 95% CI, 0.635-1.044; p = 0.106); higher CCI was associated with shorter OS (HR, 1.442; 95% CI, 1.046-1.988; p = 0.025). In the DLBCL subgroup, higher RDI was associated with longer PFS (HR, 0.217; 95% CI, 0.088-0.536; p < 0.001) and OS (HR, 0.320; 95% CI, 0.127-0.806; p = 0.016).
Conclusions:
Higher RDI was associated with longer PFS in the full cohort and DLBCL subgroup, and with longer OS in DLBCL. RDI may provide prognostic information beyond age and IPI-defined risk but may reflect physiological reserve and treatment tolerance. Prospective validation is required.
