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Published on: November 26, 2018
Comorbidity Burden and Prognosis in Patients Aged 80+ Years With Large B-Cell Lymphoma
Prokop Vodička1, Michal Masár2, Carrie A Thompson3
1First Department of Medicine, First Faculty of Medicine, Charles University and General Hospital, Prague, Czech Republic; Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN.
Background:
Patients aged 80+ years with large B-cell lymphoma (LBCL) represent a growing, vulnerable population where conventional prognostic indices inadequately capture comorbidity burden. We evaluated prognostic value of the Lymphoma Epidemiology of Outcomes Comorbidity Index (LCI) and derived simplified comorbidity model.
Methods:
In 539 patients aged 80+ years with LBCL from two independent international cohorts, we evaluated associations between comorbidities/LCI (10 comorbidity categories) and overall survival (OS) or event-free survival (EFS). discrimination and model fit were assessed using C-indices and likelihood ratio tests.
Results:
LCI categories were 0 (19%), 1 (31%), 2+ (50%). Higher LCI predicted inferior OS (LCI 1 vs. 0: hazard ratio [HR] = 1.43 [95% CI 1.04-1.97]; LCI 2+ vs. 0: HR = 1.88 [1.40-2.53]), EFS (LCI 1 vs. 0: HR = 1.37 [1.00-1.87]; LCI 2+ vs. 0: HR = 1.78 [1.33-2.38]), and higher 2-year nonlymphoma mortality (11%, 13%, and 26% for LCI 0, 1, and 2+). Heart disease (48%), prior or concurrent malignancy (9%), and stroke (8%) independently predicted OS and were combined into the MaSH Comorbidity Index (MaSH-CI; one point each), with scores 0 (44%), 1 (47%), and 2+ (9%). Higher MaSH-CI predicted inferior OS (1 vs. 0: HR = 1.59 [1.27-1.98]; 2+ vs. 0: HR = 2.43 [1.70-3.47]). Adding LCI or MaSH-CI to International Prognostic Index (IPI) or SENIOR-IPI significantly improved model fit and discrimination across all endpoints (ΔC-index 0.02-0.03).
Conclusion:
Multimorbidity strongly predicts outcomes in LBCL patients aged 80+ years. The simplified MaSH-CI adds prognostic value beyond conventional prognostic indices and offers a practical tool for risk-adapted management.