Frailty assessment to individualize treatment in older patients with lymphoma

Abstract

Purpose A study analyzing the application of a protocol of comprehensive geriatric assessment (CGA) in older patients with lymphoma was carried out to allow frailty-based patient classification and individualized treatment. Methods Lymphoma patients older than 70 years referred to the Geriatric Clinic at a tertiary hospital between May 2016 and March 2021 were included. The assessment protocol included comorbidity, polypharmacy, nutritional, functional, and mental status, geriatric syndromes, and life expectancy. CGA enabled patient classification into four groups (Type I to Type IV) based on frailty assessment instrument scoring and clinical, functional, and mental status. Variables were compared using parametric and non-parametric statistical tests and Kaplan–Meier survival curves. Results Ninety-three patients (55.9% women) were included. Median age was 81.1 years (± 5.7). 23 patients (24.7%) were classified as robust (type I), 30 (32.3%) as pre-frail (type II) with potentially reversable deficits, 38 (40.9%) as frail (type III), and 2 (2.2%) as requiring palliative care (type IV). Patients received oncospecific treatment with modifications carried out in 64.5% of cases based on CGA results. Differences in overall survival (p = 0.002), response to treatment (p < 0.001) and likelihood of increased frailty (p = 0.024) were observed, with type III–IV patients showing significantly worse outcomes. Conclusion Performance of standardized, systematic CGA by geriatricians permits older lymphoma patients to be classified according to frailty, with significant differences in terms of clinical outcomes across groups. We propose incorporating CGA performed by geriatricians as part of the multidisciplinary care team to optimize therapeutic strategy for these patients.

Appropriate Treatment Intensity for Diffuse Large B-Cell Lymphoma in the Older Population: A Review of the Literature

“…Careful administration of attenuated immunochemotherapy was shown to improve clinical outcomes and QoL in clinical practice, compared with no treatment, and CGA, abbreviated frailty assessment, and improvement in QoL were observed in a small number of cases [ 88 ]. Performance of standardized, systematic CGA by geriatricians permits older patients with lymphoma to be classified according to frailty, with significant differences in terms of clinical outcomes across groups [ 89 ]. I present my clinical approach for older patients with DLBCL ( Figure 1 ) and a paradigm shift (from management to independent) in lymphoma treatment in the older population ( Figure 2 ).…”