Clinical Outcomes, Treatment Toxicity, and Health Care Utilization in Older Adults with Aggressive <scp>Non-Hodgkin</scp> Lymphoma

Johnson, Patrick Connor; Yi, Alisha; Horick, Nora; Amonoo, Hermioni L.; Newcomb, Richard; Lavoie, Mitchell W.; Rice, Julia; Reynolds, Matthew J.; Ritchie, Christine S.; Nipp, Ryan David; El‐Jawahri, Areej

doi:10.1002/onco.13915

Cited by 5 publications

(5 citation statements)

References 42 publications

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“…This may result in discrepancies in use of the overall FENCE score as a risk parameter because patients with advanced-stage disease received high-intensity chemotherapy, which is considered a risk factor for developing FN. The factors with the highest specificity in prediction of FN were hypoalbuminemia and receipt of platinum chemotherapy, which is similar to the standard guidelines ( 4 , 14 ). Platinum-based chemotherapy is the most common form of chemotherapy ( 8 ).…”

Section: Discussionsupporting

confidence: 71%

The reliability of FEbrile Neutropenia after ChEmotherapy (FENCE) scores in predicting granulocyte colony-stimulating factor breakthrough febrile neutropenia among patients with lymphoma undergoing first-cycle chemotherapy: A prospective observational study

et al. 2023

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BackgroundA tool for estimating risk of febrile neutropenia (FN) after chemotherapy, namely the FEbrile Neutropenia after ChEmotherapy (FENCE) score, has been developed but has not been widely validated. This study aimed to validate the FENCE score as a tool for predicting granulocyte colony-stimulating factor (G-CSF) breakthrough FN among patients with lymphoma who underwent chemotherapy.MethodsThis was a prospective observational study of treatment-naive adult patients with lymphoma who underwent their first cycle of chemotherapy between 2020 and 2021. The patients were followed up until the next cycle of chemotherapy to identify any infection events.ResultsAmong the 135 patients with lymphoma, 62 (50%) were men. In a comparison of the value of each FENCE parameter for predicting G-CSF breakthrough infection, the parameter of advanced-stage disease showed high sensitivity of 92.8%, and receipt of platinum chemotherapy showed high specificity of 95.33%. With a FENCE score of 12 as a cutoff for low risk, analysis across all patients with lymphoma resulted in a high AUROCC of 0.63 (95% CI = 0.5–0.74%; p = 0.059), and analysis across only patients with diffuse large B-cell lymphoma (DLBCL) resulted in an AUROCC of 0.65 (95% CI = 0.51–0.79%; p = 0.046). With a cutoff point of 12, FENCE score can predict breakthrough infection events at 30.0% (95% CI = 17.8–47.4%).ConclusionThis study divided patients with lymphoma into risk groups according to FENCE score, showing that this instrument has discriminatory ability in predicting FN events, these being more likely to occur in patients in the intermediate- and high-risk groups. Multicenter studies are needed to validate this clinical risk score.

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Section: Discussionsupporting

confidence: 71%

The reliability of FEbrile Neutropenia after ChEmotherapy (FENCE) scores in predicting granulocyte colony-stimulating factor breakthrough febrile neutropenia among patients with lymphoma undergoing first-cycle chemotherapy: A prospective observational study

et al. 2023

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“…26,27 Moreover, a simplified geriatric assessment using age, comorbidities, and assessments of patients' activities of daily living and instrumental activities of daily living can risk stratify those with diffuse large B-cell lymphoma and could represent a novel treatment risk stratification approach. 28 Hypoalbuminemia has been shown in previous work to correlate with risk of toxicity in older adults with aggressive lymphomas, 29 but the mechanism through which it affects clinical outcomes remains unclear and could relate to nutritional status, comorbidities, and/or disease biology. 14,30 Notably, age, comorbidities, and hypoalbuminemia are clinical factors that could be readily incorporated as triggers to select patients with the greatest need for supportive care interventions such as geriatric interventions.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Health Care Utilization in Patients With Burkitt Lymphoma

Johnson

Markovitz

et al. 2023

JCO Oncology Practice

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PURPOSE Burkitt lymphoma is an aggressive B-cell lymphoma requiring intensive therapy, which places patients at risk for severe toxicity. However, few studies have described these patients' clinical outcomes and health care utilization, particularly among older adults. METHODS We conducted a retrospective analysis of adults 40 years and older with Burkitt lymphoma at Massachusetts General Hospital and Dana-Farber Cancer Institute from February 1999 to December 2020 (N = 97). We abstracted patient characteristics, clinical outcomes, and health care utilization (unplanned hospitalizations, intensive care unit [ICU] admissions) during therapy from the electronic health record. Using univariate logistic regression, we examined factors associated with rates of unplanned hospitalization and ICU admission during therapy. RESULTS Among evaluable patients (median age, 69 years; 23.7% female; 19.3% with bone marrow involvement), 45.8% (38 of 83) experienced unplanned hospitalization and 23.2% (19 of 82) experienced ICU admission during therapy. Among those 70 years and older, rates of unplanned hospitalization and ICU admission were 36.8% (14 of 38) and 29.0% (11 of 38), respectively. Bone marrow involvement (odds ratio [OR], 3.00; P = .069) was associated with a nonsignificantly greater likelihood of unplanned hospitalization. Older age (OR, 1.06; P = .039), Charlson comorbidity index >0 (OR, 3.14; P = .038), and hypoalbuminemia (OR, 3.22; P = .035) were associated with greater likelihood of ICU admission. Overall, 8.7% (8 of 92) of patients died during treatment, all of whom were 70 years and older. CONCLUSION Adults with Burkitt lymphoma experience substantial rates of unplanned hospitalizations and ICU admissions, with older adults at especially high risk for ICU admission and death during treatment. Our findings underscore the need to develop supportive care interventions for patients with Burkitt lymphoma to help improve clinical outcomes and health care utilization.

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“…Fatigue, in particular, can be severe, debilitating, and persistent even in survivorship [91][92][93]. More than 50% of NHL patients experience substantial treatment toxicities and high care utilization at the end of life [94]. One study of 91 older NHL patients with aggressive disease demonstrated that in the last 30 days of life, 70% were hospitalized, one-third received systemic Current Treatment Options in Oncology therapies, nearly one-quarter underwent admission to an intensive care unit, and more than half died in a healthcare facility.…”

Section: Symptom Burden and Palliative Care Needsmentioning

confidence: 99%

Advancing Palliative Care Integration in Hematology: Building Upon Existing Evidence

Robbins-Welty

Webb

Shalev

et al. 2023

Curr. Treat. Options in Oncol.

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Patients with hematologic malignancies and their families are among the most distressed of all those with cancer. Despite high palliative care-related needs, the integration of palliative care in hematology is underdeveloped. The evidence is clear that the way forward Current Treatment Options in Oncology includes standard-of-care PC integration into routine hematologic malignancy care to improve patient and caregiver outcomes. As the PC needs for patients with blood cancer vary significantly by disease, a disease-specific PC integration strategy is needed, allowing for serious illness care interventions to be individualized to the specific needs of each patient and situation.

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Clinical Outcomes, Treatment Toxicity, and Health Care Utilization in Older Adults with Aggressive Non-Hodgkin Lymphoma

Cited by 5 publications

References 42 publications

The reliability of FEbrile Neutropenia after ChEmotherapy (FENCE) scores in predicting granulocyte colony-stimulating factor breakthrough febrile neutropenia among patients with lymphoma undergoing first-cycle chemotherapy: A prospective observational study

The reliability of FEbrile Neutropenia after ChEmotherapy (FENCE) scores in predicting granulocyte colony-stimulating factor breakthrough febrile neutropenia among patients with lymphoma undergoing first-cycle chemotherapy: A prospective observational study

Clinical Outcomes and Health Care Utilization in Patients With Burkitt Lymphoma

Advancing Palliative Care Integration in Hematology: Building Upon Existing Evidence

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