Role of interim-PET (I-PET) in diffuse large

We performed a multicenter study in order to validate the concept that a simple CGA can identify elderly DLBCL non-fit patients in whom curative treatment is not better then palliation and to analyse potential benefits of treatment modulation after further subdividing the non-fit category by CGA criteria.One-hundred-seventy-three patients aged > 69 treated with curative or palliative intent by clinical judgment only were grouped according to CGA in fit (46%), unfit (16%) and frail (38%) categories. Two-yr OS was significantly better in fit than in non-fit patients (84% vs 47%; P <.0001). Survival in unfit and frail patients was not significantly different. Curative treatment slightly improved 2-yr OS in unfit (75% vs 44%), but not in frail patients (45% vs 39%).CGA was confirmed as very efficient in identifying elderly DLBCL patients who can benefit from a curative approach. Further efforts are needed to better tailor therapies in non-fit patients.3

PURPOSE To prospectively validate the use of a simplified geriatric assessment (sGA) at diagnosis and to integrate it into a prognostic score for older patients with diffuse large B-cell lymphoma (DLBCL). METHODS We conducted the prospective Elderly Project study on patients with DLBCL older than 64 years who underwent our Fondazione Italiana Linfomi original geriatric assessment (oGA) (age, Cumulative Illness Rating Scale for Geriatrics, activities of daily living, and instrumental activities of daily living) before treatment. Treatment choice was left to the physician's discretion. The primary end point was overall survival (OS) (ClinicalTrials.gov identifier: NCT02364050 ). RESULTS We analyzed 1,163 patients (median age 76 years), with a 3-year OS of 65% (95% CI, 62 to 68). Because at multivariate analysis on oGA, age > 80 years retained an independent correlation with OS, we also developed a new, simplified version of the GA (sGA) that classifies patients as fit (55%), unfit (28%), and frail (18%) with significantly different 3-year OS of 75%, 58%, and 43%, respectively. The sGA groups, International Prognostic Index, and hemoglobin levels were independent predictors of OS and were used to build the Elderly Prognostic Index (EPI). Three risk groups were identified: low (23%), intermediate (48%), and high (29%), with an estimated 3-year OS of 87% (95% CI, 81 to 91), 69% (95% CI, 63 to 73), and 42% (95% CI, 36 to 49), respectively. The EPI was validated using an independent external series of 328 cases. CONCLUSION The Elderly Project validates sGA as an objective tool to assess fitness status and defines the new EPI to predict OS of older patients with DLBCL.

Our results demonstrate the role of an early PET scan as a significant step forward in the management of patients with early-stage or advanced-stage HL.

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