Impact of comorbidities on the treatment of non-Hodgkin’s lymphoma: a systematic review

Abstract

Treating non-Hodgkin's lymphoma in patients with comorbidities can be challenging because of possible interactions that may alter the treatment efficacy. We conducted a systematic review to determine the impact of comorbidities on various outcomes, evaluate the current data, and provide recommendations for future research. Twenty-one articles were selected. However, the study populations and design were greatly heterogeneous, and the quality of reporting was generally weak. The majority of studies demonstrated significant impact of comorbidity on survival, reporting poorer survival rates for patients with comorbidities compared to those with no comorbidities. However, the existing evidence is limited and of insufficient quality to establish solid conclusions and to guide treatment decisions. Prospective, well-designed studies are warranted.

Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B‐cell lymphoma: a Swedish lymphoma register study

“…Overall, Terret et al . did not find evidence for an association between CCI and choice of chemotherapy regimen or completion of treatment in their review. However, they confirm findings from several prior studies, restricted to patients who have received treatment, that CCI is associated with a higher frequency of grade III/IV toxicities, dose reductions and in the majority of studies, with inferior OS [].…”

“…The majority of studies that have evaluated the prognostic influence of comorbidity in DLBCL have been nonpopulation‐based, limited in size (median n = 165, range 41–387 as reviewed by Terret et al . ), and restricted to an elderly population . Although the majority of these studies demonstrate an association between a high comorbidity index and inferior overall survival (OS), lower response rates or increased therapy‐related toxicities, some do not .…”

“…First, it is a competing cause of death. Secondly, it likely influences the use, intensity and efficacy of chemotherapy, although the reported impact of comorbidity on treatment choice differs . Also, most studies have not investigated putative effects of specific comorbid disease entities separately .…”

Potentially inappropriate medication use in elderly non‐Hodgkin lymphoma patients is associated with reduced survival and increased toxicities

“…In addition, it is unclear how geriatric syndrome contributes to outcomes. A systematic review has found that increasing numbers of comorbidities adversely affect survival in NHL (Terret et al, 2015). Similar studies have identified poor nutrition, low hemoglobin, and frailty as risk factors for early treatment withdrawal and poor outcome (Park et al, 2015; Aaldriks et al, 2015).…”

Precision medicine in follicular lymphoma: Focus on predictive biomarkers

“…Most precision medicine has focused on the biological features of the disease (as opposed to the patient) and on younger and generally healthier individuals who are offered entry into clinical trials. [118][119][120][121] There is growing awareness of the difference of results in clinical trials vs clinical practice (the efficacy-effectiveness gap 122 ), according to which there is comparatively little evidence on the optimal care of older and more comorbid patients. Although there are some published experiences with comorbidity scores and geriatric scales, 123,124 most of them are retrospective or observational, with little controlled evidence.…”