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Yhim HY, Park Y, Kim JA, Shin HJ, Do YR, Moon JH, Kim MK, Lee WS, Kim DS, Lee MW, Choi YS, Jeong SH, Kim KH, Kim J, Lee CH, Song GY, Yang DH, Kwak JY. Geriatric risk model for older patients with diffuse large B-cell lymphoma (GERIAD): a prospective multicenter cohort study. Korean J Intern Med 2024; 39:501-512. [PMID: 38287501 PMCID: PMC11076889 DOI: 10.3904/kjim.2023.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND/AIMS Optimal risk stratification based on simplified geriatric assessment to predict treatment-related toxicity and survival needs to be clarified in older patients with diffuse large B-cell lymphoma (DLBCL). METHODS This multicenter prospective cohort study enrolled newly diagnosed patients with DLBCL (≥ 65 yr) between September 2015 and April 2018. A simplified geriatric assessment was performed at baseline using Activities of Daily Living (ADL), Instrumental ADL (IADL), and Charlson's Comorbidity Index (CCI). The primary endpoint was event-free survival (EFS). RESULTS The study included 249 patients, the median age was 74 years (range, 65-88), and 125 (50.2%) were female. In multivariable Cox analysis, ADL, IADL, CCI, and age were independent factors for EFS; an integrated geriatric score was derived and the patients stratified into three geriatric categories: fit (n = 162, 65.1%), intermediate-fit (n = 25, 10.0%), and frail (n = 62, 24.9%). The established geriatric model was significantly associated with EFS (fit vs. intermediate-fit, HR 2.61, p < 0.001; fit vs. frail, HR 4.61, p < 0.001) and outperformed each covariate alone or in combination. In 87 intermediate-fit or frail patients, the relative doxorubicin dose intensity (RDDI) ≥ 62.4% was significantly associated with worse EFS (HR, 2.15, 95% CI 1.30-3.53, p = 0.002). It was related with a higher incidence of grade ≥ 3 symptomatic non-hematologic toxicities (63.2% vs. 27.8%, p < 0.001) and earlier treatment discontinuation (34.5% vs. 8.0%, p < 0.001) in patients with RDDI ≥ 62.4% than in those with RDDI < 62.4%. CONCLUSION This model integrating simplified geriatric assessment can risk-stratify older patients with DLBCL and identify those who are highly vulnerable to standard dose-intensity chemoimmunotherapy.
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Affiliation(s)
- Ho-Young Yhim
- Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
| | - Yong Park
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Jeong-A Kim
- Department of Internal Medicine, The Catholic University of Korea, St. Vincent Hospital, Suwon,
Korea
| | - Ho-Jin Shin
- Department of Internal Medicine, Pusan National University Hospital, Busan,
Korea
| | - Young Rok Do
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu,
Korea
| | - Joon Ho Moon
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu,
Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan,
Korea
| | - Dae Sik Kim
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Myung-Won Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Yoon Seok Choi
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon,
Korea
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Kyoung Ha Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Jinhang Kim
- Department of Internal Medicine, The Catholic University of Korea, St. Vincent Hospital, Suwon,
Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
| | - Ga-Young Song
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Deok-Hwan Yang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jae-Yong Kwak
- Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju,
Korea
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de Pádua Covas Lage LA, De Vita RN, de Oliveira Alves LB, Jacomassi MD, Culler HF, Reichert CO, de Freitas FA, Rocha V, Siqueira SAC, de Oliveira Costa R, Pereira J. Predictors of Survival, Treatment Modalities, and Clinical Outcomes of Diffuse Large B-Cell Lymphoma in Patients Older Than 70 Years Still an Unmet Medical Need in 2024 Based on Real-World Evidence. Cancers (Basel) 2024; 16:1459. [PMID: 38672542 PMCID: PMC11048621 DOI: 10.3390/cancers16081459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) especially affects the older population. Old (≥60 years) and very old age (≥80 years) DLBCL patients often present high-risk molecular alterations, lower tolerability to conventional immunochemotherapy, and poor clinical outcomes. In this scenario, attenuated therapeutic strategies, such as the R-MiniCHOP and R-MiniCHOP of the elderly regimens, have emerged for this particularly fragile population. However, the responses, clinical outcomes, and toxicities of these regimens currently remain poorly understood, mainly because these individuals are not usually included in controlled clinical trials. METHODS This retrospective, observational, and single-center real-world study included 185 DLBCL, NOS patients older than 70 years treated at the largest oncology center in Latin America from 2009 to 2020. We aimed to assess the outcomes, determine survival predictors, and compare responses and toxicities between three different primary therapeutic strategies, including the conventional R-CHOP regimen and the attenuated R-MiniCHOP and R-MiniCHOP of the elderly protocols. RESULTS The median age at diagnosis was 75 years (70-97 years), and 58.9% were female. Comorbidities were prevalent, including 19.5% with immobility, 28.1% with malnutrition, and 24.8% with polypharmacy. Advanced clinical stage was observed in 72.4%, 48.6% had bulky disease ≥7 cm, 63.2% had B-symptoms, and 67.0% presented intermediate-high/high-risk IPI. With a median follow-up of 6.3 years, the estimated 5-year OS and PFS were 50.2% and 44.6%, respectively. The R-MiniCHOP of the elderly regimen had a lower ORR (p = 0.040); however, patients in this group had higher rates of unfavorable clinical and laboratory findings, including hypoalbuminemia (p = 0.001), IPI ≥ 3 (p = 0.013), and NCCN-IPI ≥ 3 (p = 0.002). Although associated with higher rates of severe neutropenia (p = 0.003), the R-CHOP regimen promoted increased OS (p = 0.003) and PFS (p = 0.005) in comparison to the attenuated protocols. Additionally, age ≥ 75 years, high levels of LDH, B-symptoms, advanced clinical stage (III/IV), neutrophilia, and low lymphocyte/monocyte ratio were identified as poor prognostic factors in this cohort. CONCLUSIONS In this large and real-life Latin American cohort, we demonstrated that patients with DLBCL, NOS older than 70 years still do not have satisfactory clinical outcomes in 2024, with half of cases not reaching 5 years of life expectancy after diagnosis. Although the conventional R-CHOP offers response and survival advantages over attenuated regimens, its myelotoxicity is not negligible. Therefore, the outcomes reported and the prognostic factors here identified may assist clinicians in the appropriate selection of therapeutic strategies adapted to the risk for old and very old DLBCL patients.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Rita Novello De Vita
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Lucas Bassolli de Oliveira Alves
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Mayara D’Auria Jacomassi
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Cadiele Oliana Reichert
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Fábio Alessandro de Freitas
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Fundação Pró-Sangue, Blood Bank of São Paulo, São Paulo 05403000, Brazil
- Department of Hematology & Hemotherapy, Churchill Hospital, Oxford University, Oxford OX3 7LE, UK
| | | | - Renata de Oliveira Costa
- Department of Hematology & Hemotherapy, Faculty of Medicine, Centro Universitário Lusíada (Unilus), Santos 11045101, Brazil;
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
| | - Juliana Pereira
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
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Bertucci A, Harlay V, Chinot O, Tabouret E. Primary central nervous system lymphoma (PCNSL) in older patients. Curr Opin Oncol 2023; 35:373-381. [PMID: 37498077 DOI: 10.1097/cco.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Primary central nervous system lymphoma (PCNSL) is a rare, chemo and radio-sensitive tumor limited to the central nervous system. The incidence of PCSNL increases notably in the elderly population which represented approximately half of the patients. The limit of 'elderly' population remained debated and nonuniform, including 60 years as a cutoff for brain radiotherapy, 65 years for autologous stem-cell transplantation, and 70 years for the last clinical trials. Current therapeutic options include first line treatment based on high-dose methotrexate based polychemotherapy, consolidation chemotherapy, and adapted autologous stem cell transplantation for highly selected patients. At relapse, single agent targeted therapies or salvage chemotherapy followed by intensive consolidation are promising therapeutic options. Nevertheless, improving management of elderly patients is an urgent medical need that currently remains unresolved. OBJECTIVE We will focus on elderly patients with PCNSL and their specificities including clinical presentations, available therapeutic options and adaptations to be made. CONCLUSION To improve survival, it will be necessary to personalized and adapt the treatments, to each patient and his comorbidities, to increase their effectiveness and limit their toxicity in this frail population. Finally, inclusion of these patients in clinical trials is one of the major challenges to significantly change PCNSL elderly patient prognosis.
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Affiliation(s)
| | | | - Olivier Chinot
- APHM, CHU Timone, Service de Neurooncologie
- Aix-Marseille University, CNRS, INP, Inst Neurophysiopathol, Marseille, France
| | - Emeline Tabouret
- APHM, CHU Timone, Service de Neurooncologie
- Aix-Marseille University, CNRS, INP, Inst Neurophysiopathol, Marseille, France
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Pénichoux J, Lanic H, Thill C, Ménard AL, Camus V, Stamatoullas A, Lemasle E, Leprêtre S, Lenain P, Contentin N, Kraut-Tauzia J, Fruchart C, Kammoun L, Damaj G, Farge A, Delette C, Modzelewski R, Vaudaux S, Pépin LF, Tilly H, Jardin F. Prognostic relevance of sarcopenia, geriatric, and nutritional assessments in older patients with diffuse large B-cell lymphoma: results of a multicentric prospective cohort study. Ann Hematol 2023; 102:1811-1823. [PMID: 37058153 PMCID: PMC10260702 DOI: 10.1007/s00277-023-05200-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/23/2023] [Indexed: 04/15/2023]
Abstract
This prospective study aimed to investigate the prognostic effect of sarcopenia, geriatric, and nutritional status in older patients with diffuse large B-cell lymphoma (DLBCL). Ninety-five patients with DLBCL older than 70 years who were treated with immunochemotherapy were included. The lumbar L3 skeletal muscle index (L3-SMI) was measured by computed tomography at baseline, and sarcopenia was defined as low L3-SMI. Geriatric assessment included G8 score, CIRS-G scale, Timed Up and Go test, and instrumental activity of daily living. Nutritional status was assessed using the Mini Nutritional Assessment and the body mass index, and several scores used in the literature incorporating nutritional and inflammatory biomarkers, namely the Nutritional and inflammatory status (NIS), Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Glasgow Prognostic Score.Fifty-three patients were considered sarcopenic. Sarcopenic patients displayed higher levels of inflammation markers and lower levels of prealbumin than non-sarcopenic patients. Sarcopenia was associated with NIS, but was not associated with severe adverse events and treatment disruptions. They were, however, more frequent among patients with elevated NIS. Sarcopenia did not appear in this study as a prognostic factor for progression-free survival (PFS) or overall survival (OS). However, NIS emerged as predictive of the outcome with a 2-year PFS rate of 88% in the NIS ≤ 1 group and 49% in the NIS > 1 group and a significant effect in a multivariate analysis for both PFS (p = 0.049) and OS (HR = 9.61, CI 95% = [1.03-89.66], p = 0.04). Sarcopenia was not associated with adverse outcomes, but was related to NIS, which appeared to be an independent prognostic factor.
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Affiliation(s)
- Juliette Pénichoux
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France.
| | - Hélène Lanic
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Caroline Thill
- Department of Statistics, Rouen University Hospital, Rouen, France
| | - Anne-Lise Ménard
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Vincent Camus
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Aspasia Stamatoullas
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Pascal Lenain
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
| | | | | | - Leila Kammoun
- Department of Oncology-Hematology, Eure-Seine Hospital Center, Evreux, France
| | - Gandhi Damaj
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Agathe Farge
- Institute of Hematology, Caen University Hospital, Caen, France
| | - Caroline Delette
- Department of Clinical Hematology, Amiens University Hospital, Amiens, France
| | | | - Sandrine Vaudaux
- Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | | | - Hervé Tilly
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Centre Henri Becquerel, 1 Rue d'Amiens, 76038, Rouen, France
- INSERM U1245 Unit, Team "Genetic and Biomarkers in Lymphoma and Solid Tumors", Rouen University, Centre Henri Becquerel, Rouen, France
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Hung YS, Chang H, Wang PN, Kuo MC, Su YJ, Hung CY, Hsueh SW, Yeh KY, Ho YW, Chou WC. Pretreatment frailty is an independent prognostic factor among elderly patients with B-cell lymphoma undergoing immunochemotherapy: A prospective observational cohort study in Taiwan. Asia Pac J Clin Oncol 2023; 19:62-70. [PMID: 35403372 DOI: 10.1111/ajco.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND/PURPOSE Frailty is a common clinical syndrome among the elderly; however, it is frequently neglected in patients with hematological malignancies, especially among the Asian population. This study is aimed to evaluate the prevalence and effect of frailty on survival outcomes in elderly Asian patients with B-cell lymphoma. METHODS We prospectively enrolled 76 consecutive patients with age ≥ 65 years and newly diagnosed B-cell lymphoma and were receiving immunochemotherapy in a medical center in Taiwan between August 2016 and December 2017. The frailty of all patients was assessed using a comprehensive geriatric assessment (CGA) within 7 days before immunochemotherapy. RESULTS Twenty-seven patients (36%) were allocated to the frail group based on CGA. With a median follow-up duration of 26.5 (range, 1.7-39.8) months, the 1- and 2-year survival rates were 68% and 58%, respectively, for all group of patients. In patients in the non-frail group, the 1-year and 2-year survival rates were 81% and 71%, respectively, compared to 44% and 33%, respectively, in the frail group (hazard ratio [HR], 3.57, 95% confidence interval [CI], 1.74-7.30; p = 0.001). Age ≥ 75years (adjusted HR 2.57, 95% CI 1.02-6.47, p = 0.045), presence of B-symptoms (adjusted HR 2.43, 95% CI 1.05-5.60, p = 0.038), and frailty (adjusted HR 3.03, 95% CI 1.29-7.11, p = 0.011) were independent prognostic factors in the multivariate analysis. CONCLUSION Frailty significantly influenced the survival outcome as an independent prognostic factor in elderly patients with B-cell lymphoma undergoing immunochemotherapy. Pretreatment frailty assessment is critical to assist clinicians and patients with B-cell lymphoma with prognosis prediction and counseling on an appropriate treatment goal.
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Affiliation(s)
- Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung Chang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Nan Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chung Kuo
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jiun Su
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hema-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kun-Yun Yeh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Ya-Wen Ho
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hema-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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Leclair NK, Terai H, Paro M, Blechner M, Gershon A, Becker K, Onyiuke H. Spinal Lymphoma Presenting as an Epidural and Retropleural Mass With Concomitant Pathologic Compression Fracture: A Case Report. Cureus 2022; 14:e31155. [DOI: 10.7759/cureus.31155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
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7
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Miura K, Takahashi H, Nakagawa M, Hamada T, Uchino Y, Iizuka K, Ohtake S, Iriyama N, Hatta Y, Nakamura H. Ideal dose intensity of R-CHOP in diffuse large B-cell lymphoma. Expert Rev Anticancer Ther 2022; 22:583-595. [PMID: 35472312 DOI: 10.1080/14737140.2022.2071262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, its ideal dose intensity varies among cases. AREAS COVERED This review provides the latest insights on the dose intensity of R-CHOP for DLBCL patients. Specifically, we discussed the optimal dose intensity for elderly patients, the optimal number of treatment cycles for limited or advanced-stage diseases, and the role of dose-intensified therapies or adding targeted inhibitors. EXPERT OPINION Performing a comprehensive or simplified geriatric assessment can distinguish elderly DLBCL patients who will likely benefit from curative R-CHOP. Very elderly or medically unfit patients may need dose reduction in R-CHOP; the Age, Comorbidities, and Albumin index may aid decision-making. Four cycles of R-CHOP followed by two rituximab cycles comprise a new standard for low-risk, limited-stage DLBCL patients. Compared to eight cycles, six cycles of R-CHOP have similar efficacy and fewer toxicities for advanced-stage DLBCL. Dose-intensified therapy is not recommended in most DLBCL cases but may be considered for patients with double (or triple)-hit lymphoma. Applying targeted inhibitors and not merely escalating R-CHOP dose intensity through molecular subtyping will improve the treatment outcome for DLBCL.
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Affiliation(s)
- Katsuhiro Miura
- Tumor Center, Nihon University Itabashi Hospital (Director); 2Department of Hematology and Rheumatology, Nihon University School of Medicine (Associate Professor), Tokyo, Japan.,Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromichi Takahashi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Masaru Nakagawa
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Takashi Hamada
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihito Uchino
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Iizuka
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Shimon Ohtake
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Nakamura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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Miyazaki K. Management of elderly patients with malignant lymphoma. Jpn J Clin Oncol 2022; 52:690-699. [PMID: 35435235 DOI: 10.1093/jjco/hyac056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/02/2022] [Indexed: 11/14/2022] Open
Abstract
More than half of patients with malignant lymphoma are 65 years old or older. The outcome for older patients is poorer than that for younger patients. A poor prognosis is associated with heterogeneity and consists of physical function, performance status, poor nutritional status and various comorbidities. Therefore, attention should be given to serious treatment-related toxicities. Diffuse large B-cell lymphoma is the most frequently diagnosed type of malignant lymphoma. Most patients with diffuse large B-cell lymphoma can be potentially cured with the current standard chemotherapeutic regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. However, a reduced-dose regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone or alternative treatment options might be suitable for older patients who are frail or unfit and have cardiac comorbidities. A comprehensive geriatric assessment is a potential tool for determining an appropriate therapeutic approach for each older patient. Follicular lymphoma is the second most common type of non-Hodgkin lymphoma, and the disease course is usually characterized by an indolent clinical course. Advanced follicular lymphoma with a high tumor burden has historically been treated with chemoimmunotherapy, but the treatment goal for older patients is relief of symptoms. Incorporating novel targeted agents such as brentuximab vedotin into therapies for older Hodgkin lymphoma patients might be a promising alternative to the anthracycline-containing regimen.
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Affiliation(s)
- Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
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Vovelle J, Row C, Larosa F, Guy J, Mihai AM, Maynadié M, Barben J, Manckoundia P. Prescription of Blood Lymphocyte Immunophenotyping in the Diagnosis of Lymphoid Neoplasms in Older Adults. J Clin Med 2022; 11:jcm11061748. [PMID: 35330073 PMCID: PMC8949070 DOI: 10.3390/jcm11061748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Lymphoid neoplasms are a heterogeneous group of lymphoid neoplastic diseases with multiple presentations, and varying prognoses. They are especially frequent in older patients (OPs) and the atypism of this frail elderly population can make the diagnostic process even more difficult. Blood lymphocyte immunophenotyping (BLI) is essential in rapid noninvasive diagnosis orientation and guides complementary investigations. To our knowledge, BLI prescription has never been evaluated in OPs. We hypothesized that, when there is a suspicion of lymphoid neoplasm in the geriatric population, a BLI is performed in view of various clinical or biological abnormalities. This study aimed to: (1) describe the characteristics of hospitalized OPs having undergone BLI for suspected lymphoid neoplasm, (2) identify the causes leading to BLI prescription, and (3) identify the most profitable criteria for BLI prescription. This was a descriptive retrospective study on 151 OPs aged ≥75 years who underwent BLI over a 2-year period. Regarding BLI prescriptions, eight had lymphocytosis, constituting the “lymphocytosis group” (LG+), while the 143 others had BLI prescribed for reasons other than lymphocytosis (LG−), mainly general weakness and anemia. In the LG−, we compared OPs with positive and negative BLI results. The criteria found to be profitable for BLI prescription were lymphadenopathy, splenomegaly, lymphocytosis, and thrombocytopenia. BLI identified circulating lymphoid neoplasms (positive BLI) in 21/151 OPs, mainly marginal zone lymphoma and chronic lymphocytic leukemia. In polymorbid OPs, as per our study population, the diagnostic and therapeutic complexity explained in part the sole use of indirect and minimally invasive diagnostic techniques such as BLI.
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Affiliation(s)
- Jérémie Vovelle
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France; (J.V.); (F.L.); (A.-M.M.); (J.B.)
| | - Céline Row
- Department of Biological Hematology, University Hospital, 21079 Dijon, France; (C.R.); (J.G.); (M.M.)
| | - Fabrice Larosa
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France; (J.V.); (F.L.); (A.-M.M.); (J.B.)
| | - Julien Guy
- Department of Biological Hematology, University Hospital, 21079 Dijon, France; (C.R.); (J.G.); (M.M.)
| | - Anca-Maria Mihai
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France; (J.V.); (F.L.); (A.-M.M.); (J.B.)
| | - Marc Maynadié
- Department of Biological Hematology, University Hospital, 21079 Dijon, France; (C.R.); (J.G.); (M.M.)
| | - Jérémy Barben
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France; (J.V.); (F.L.); (A.-M.M.); (J.B.)
| | - Patrick Manckoundia
- “Pôle Personnes Âgées”, Hospital of Champmaillot, University Hospital, 21079 Dijon, France; (J.V.); (F.L.); (A.-M.M.); (J.B.)
- INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-380-29-39-70; Fax: +33-380-29-36-21
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10
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Di M, Keeney T, Belanger E, Panagiotou OA, Olszewski AJ. Global Risk Indicator and Therapy for Older Patients With Diffuse Large B-Cell Lymphoma: A Population-Based Study. JCO Oncol Pract 2022; 18:e383-e402. [PMID: 34846916 PMCID: PMC8932488 DOI: 10.1200/op.21.00513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/04/2021] [Accepted: 10/27/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To examine the impact of global risk, a measure comprising age, comorbidities, function, and cognitive statuses, on treatment selection and outcomes among older home care recipients with diffuse large B-cell lymphoma. METHODS From SEER-Medicare, we selected home care recipients diagnosed with diffuse large B-cell lymphoma in 2011-2015, who had pretreatment Outcome and Assessment Information Set (OASIS) evaluations. We created a global risk indicator categorizing patients as low-, moderate-, or high-risk on the basis of OASIS assessments. We examined the association of global risk with receipt of therapy and among chemotherapy recipients, with mortality, emergency department visits, hospitalization, and intensive care unit admission within 30 days from first treatment in logistic models, reporting adjusted odds ratios (OR) with 95% CI. We compared overall survival across risk groups estimating adjusted hazard ratios. RESULTS Of the 1,232 patients (median age, 80 years), 65% received chemotherapy. High-risk patients (v moderate-risk) were less likely to receive any chemotherapy (OR, 0.50; 95% CI, 0.39 to 0.64) and curative regimens (OR, 0.59; 95% CI, 0.40 to 0.86) if treated, although even in the moderate-risk group, only 61% received curative regimens. High-risk patients were more likely to experience acute mortality (OR, 2.24; 95% CI, 1.43 to 3.52), emergency department visits (OR, 1.35; 95% CI, 1.00 to 1.83), hospitalization (OR, 1.60; 95% CI, 1.19 to 2.17), or intensive care unit admission (OR, 1.52; 95% CI, 1.04 to 2.22) and had inferior overall survival (hazard ratio, 1.41; 95% CI, 1.11 to 1.78). CONCLUSION Global risk on the basis of OASIS is easily available, suggesting a potential way to improve patient selection for curative treatment and institution of preventive measures.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology/Oncology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT
| | - Tamra Keeney
- Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Emmanuelle Belanger
- Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
| | - Orestis A. Panagiotou
- Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Adam J. Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI
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Akhtar OS, Huang LW, Tsang M, Torka P, Loh KP, Morrison VA, Cordoba R. Geriatric assessment in older adults with Non-Hodgkin lymphoma: A Young International Society of Geriatric Oncology (YSIOG) review paper. J Geriatr Oncol 2022; 13:572-581. [PMID: 35216939 DOI: 10.1016/j.jgo.2022.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a disease of older adults, with a median age at diagnosis of 67 years. Treatment in older adults with NHL is challenging. The aging process is associated with a decline in functional reserve that varies among individuals, and results in an increasing risk of treatment-related toxicity and mortality. Chronological age and performance status fail to capture the multidimensional and heterogeneous nature of the aging process. A geriatric assessment (GA) screens multiple geriatric domains and provides a more accurate assessment of functional reserve. Several abbreviated GA tools have been developed for use in oncology clinics and help identify patients at high risk for chemotherapy-related toxicity and mortality. In this review, we explore GA tools validated for use in patients with NHL. We discuss the evidence behind GA-guided treatment in NHL and present a suggested approach to assessing frailty in this patient population.
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Affiliation(s)
| | - Li-Wen Huang
- San Francisco VA Medical Center, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mazie Tsang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Vicki A Morrison
- Hennepin Healthcare/University of Minnesota, Minneapolis, MN, USA
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
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12
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Zhang J, Disperati P, Elinder-Camburn A, Merriman E, Leitch S, Chan H. Electronic FRAIL score as a predictor of treatment outcomes in older patients with diffuse large B-cell lymphoma. J Geriatr Oncol 2021; 13:505-510. [PMID: 34906444 DOI: 10.1016/j.jgo.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Frailty is a significant risk factor for poor outcomes among older patients with diffuse large B-cell lymphoma (DLBCL). We present an automatically derived electronic frailty screening tool (FRAIL score) as a predictor of patient outcomes. METHODS Patients aged 70 or over who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy for DLBCL between 2010 and ` were retrospectively assessed for their FRAIL scores. Measured treatment outcomes included overall survival (OS), progression-free survival (PFS), and treatment-limiting toxicity from chemotherapy. RESULTS A total of 96 patients were analysed. When stratified by FRAIL score, the estimated 5-year PFS was 58%, 48% and, 0% for those with scores of 0-1, 2, and 3-5, respectively (p = 0.012). Similarly, the estimated 5-year OS for these respective groups was 60%, 60% and 0% (p = 0.010). Patients with a FRAIL score of 3-5 were also more likely than those with a score of 0-1 to need dose reduction or treatment delay due to toxicity (odds ratio [OR] 12.5, 95% confidence interval [CI] 10.42-109.72) and less likely to complete the six planned cycles of treatment (OR 0.14, 95% CI 0.03-0.77). CONCLUSION The FRAIL score is independently predictive of OS, PFS, and treatment-related toxicity in older patients with DLBCL receiving R-CHOP chemotherapy. Once implemented, it provides a quick and accessible method to stratify disease and treatment-related risk among these patients.
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Affiliation(s)
- Jesse Zhang
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
| | - Patricia Disperati
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
| | - Anna Elinder-Camburn
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
| | - Eileen Merriman
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
| | - Sophie Leitch
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand
| | - Henry Chan
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
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Briand M, Gerard S, Gauthier M, Garric M, Steinmeyer Z, Balardy L. Impact of therapeutic management and geriatric evaluation on patient of eighty years and older with diffuse large B-cell lymphoma on survival: A systematic review. Eur J Haematol 2021; 108:3-17. [PMID: 34496073 DOI: 10.1111/ejh.13704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Diffuse large B cell lymphoma (DLBCL) is an aggressive disease. The first-line treatment is well defined in young patients; however, in oldest old patients treatment remains unclear. OBJECTIVES To investigate the impact of therapeutics management and geriatric evaluation on survival in aged patients with DLBCL. METHODS We performed a systematic review of PubMed and COCHRANE databases of published report on elderly patients (median age 80 and above) with DLBCL, from January 2002 to January 2020. RESULTS We included 32 studies (6 prospective and 26 retrospective). Patients treated with anthracyclines-containing chemoimmunotherapy had a 2-year overall survival (OS) of 59%-74.3% in prospective studies and 48.1-64.6% in retrospective studies. With less intensive treatment without anthracyclines, 2-year OS was 28%-53%. Without specific treatment, median OS was 2 months. History of falls and severe comorbidities were associated with a decreased survival. CONCLUSIONS Chemoimmunotherapy with anthracyclines increases survival in selected very elderly patients in comparison with less intensive regimen. Geriatric assessment, in particular altered mobility disorders and severe comorbidities, is predictive of survival and should be associated with the therapeutic decision. More comparative studies are needed to guide the management of frailer patients.
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Affiliation(s)
- Marguerite Briand
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stephane Gerard
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Martin Gauthier
- Department of Hematology, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.,Department of Internal Medicine, Centre Hospitalier de Cahors, Cahors, France
| | - Marie Garric
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Zara Steinmeyer
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Laurent Balardy
- Geriatric Department, Internal Medicine and Oncogeriatry Unit, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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14
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Martinez-Calle N, Isbell LK, Cwynarski K, Schorb E. Advances in treatment of elderly primary central nervous system lymphoma. Br J Haematol 2021; 196:473-487. [PMID: 34448202 DOI: 10.1111/bjh.17799] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The management of older individuals (≥60 years) with primary central nervous system lymphoma remains a clinical challenge. Identification of optimal therapy and delivering adequate dose intensity are two of the major issues in treating elderly patients. Premorbid performance status and comorbidities influence individualised treatment approaches and geriatric assessment tools are increasingly utilised. Optimal induction treatment remains high-dose methotrexate-based immunochemotherapy, delivery is feasible in the majority of patients and the goal of treatment remains achieving complete remission. Consolidation strategies are also relevant in the elderly, aiming to maximise duration of response and quality of life (QoL). Potential options include high-dose therapy with haematopoietic stem cell consolidation, non-myeloablative chemotherapy and whole-brain radiotherapy. Efficacy of novel agents, such as Bruton tyrosine kinase inhibitors and lenalidomide, have been reported; these represent an alternative for elderly patients unfit for chemotherapy. Prognosis remains poor, improvement of outcomes in this age group is urgently needed.
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Affiliation(s)
- Nicolas Martinez-Calle
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Lisa K Isbell
- Department of Haematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - Elisabeth Schorb
- Department of Haematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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15
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Tavares A, Moreira I. Diffuse large B-cell lymphoma in very elderly patients: Towards best tailored treatment - A systematic review. Crit Rev Oncol Hematol 2021; 160:103294. [PMID: 33675907 DOI: 10.1016/j.critrevonc.2021.103294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/02/2021] [Accepted: 02/27/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Diffuse large B cell Lymphoma (DLBCL) is a potentially curative lymphoma with increasing incidence with ageing. Treatment of elderly DLBCL patients represents a particular challenge due to their comorbidities and performance status. METHODS A search for original articles focused on the treatment of elderly DLBCL patients was performed in PubMed database and 633 were found and reviewed. Thirty-eight studies meeting our inclusion criteria were published since 2007. RESULTS Thirteen studies were retrospective and 25 phase II/III clinical trials. Most of them investigated the efficacy of dose-adjusted R-CHOP regimen. Alternative therapeutic drugs together with geriatric assessment were also evaluated. For fit patients aged 80 and over, the strongest evidence favours R-miniCHOP regimen. CONCLUSION A dose-adjusted R-CHOP may be the recommended treatment in elderly DLBCL patients. New tools such as the Comprehensive Geriatric Assessment provide useful guidance for treatment choice, based on comorbidities and frailty index of this group.
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Affiliation(s)
- Alda Tavares
- Department of Medical Oncology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal.
| | - Ilídia Moreira
- Department of Onco-Hematology, Portuguese Institute of Oncology of Porto, Porto, Portugal
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16
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Merli F, Luminari S, Tucci A, Arcari A, Rigacci L, Hawkes E, Chiattone CS, Cavallo F, Cabras G, Alvarez I, Fabbri A, Re A, Puccini B, Barraclough A, Delamain MT, Ferrero S, Usai SV, Ferrari A, Cencini E, Pennese E, Zilioli VR, Marino D, Balzarotti M, Cox MC, Zanni M, Di Rocco A, Lleshi A, Botto B, Hohaus S, Merli M, Sartori R, Gini G, Nassi L, Musuraca G, Tani M, Bottelli C, Kovalchuk S, Re F, Flenghi L, Molinari A, Tarantini G, Chimienti E, Marcheselli L, Mammi C, Spina M. Simplified Geriatric Assessment in Older Patients With Diffuse Large B-Cell Lymphoma: The Prospective Elderly Project of the Fondazione Italiana Linfomi. J Clin Oncol 2021; 39:1214-1222. [PMID: 33577377 DOI: 10.1200/jco.20.02465] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.,Department CHIMOMO, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Tucci
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | - Annalisa Arcari
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Luigi Rigacci
- Haematology Unit, Careggi University Hospital, Firenze, Italy
| | - Eliza Hawkes
- Department of Oncology and Clinical Haematology, Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Melbourne, Australia
| | - Carlos S Chiattone
- Santa Casa Medical School, Sao Paulo, Brazil.,Samaritano Hospital, Sao Paulo, Brazil
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino," Torino, Italy
| | - Giuseppina Cabras
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Isabel Alvarez
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Alessandro Re
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | | | | | | | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU "Città della Salute e della Scienza di Torino," Torino, Italy
| | - Sara Veronica Usai
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Elsa Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara, Italy
| | | | - Dario Marino
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Monica Balzarotti
- Department of Medical Oncology and Hematology, Humanitas Clinical Research Hospital-IRCCS, Rozzano (MI), Italy
| | | | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Alice Di Rocco
- Institute of Hematology, Department of Translational and Precision Medicine "Sapienza," University of Roma, Roma, Italy
| | - Arben Lleshi
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
| | - Barbara Botto
- Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Stefan Hohaus
- University Policlinico Gemelli Foundation-IRCCS, Catholic University of the Sacred Heart, Roma, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Roberto Sartori
- Department of Clinical and Experimental Oncology, Oncohematology Unit, Veneto Institute of Oncology, IOV-IRCCS, Castelfranco Veneto (TV), Italy
| | - Guido Gini
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Luca Nassi
- Hematology, AOU Maggiore della Carità and University of Eastern Piedmont, Novara, Italy
| | - Gerardo Musuraca
- Hematology Unit, IRCCS-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) SRL, Meldola (FC), Italy
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Chiara Bottelli
- Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy
| | - Sofia Kovalchuk
- Haematology Unit, Careggi University Hospital, Firenze, Italy
| | - Francesca Re
- Hematology and BMT Center, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Leonardo Flenghi
- Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Giuseppe Tarantini
- Haematology and BMT Unit, Ospedale Monsignor R. Dimiccoli, Barletta, Italy
| | - Emanuela Chimienti
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
| | | | - Caterina Mammi
- Gruppo Amici dell'Ematologia GRADE-Onlus Foundation, Reggio Emilia, Italy
| | - Michele Spina
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
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Candelaria M, Dueñas-Gonzalez A. Rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in diffuse large B-cell lymphoma. Ther Adv Hematol 2021; 12:2040620721989579. [PMID: 33796235 PMCID: PMC7970687 DOI: 10.1177/2040620721989579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/04/2021] [Indexed: 01/05/2023] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the most frequent non-Hodgkin lymphoma worldwide. The current standard of care is chemoimmunotherapy with an R-CHOP regimen. We aim to review the role of this regimen after two decades of being the standard of care. Methods A comprehensive literature review of DLBCL, including the epidemiology, trials defining R-CHOP as the standard of care, as well as dose intensification and dose reduction schemes. Additionally, we briefly review the development of rituximab biosimilars and the addition of targeted drugs to R-CHOP in clinical trials. Discussion R-CHOP cures approximately 70% of DLBCL patients. Dose-dense regimens do not show a benefit in response and increase toxicity. Dose reduction, particularly in elderly patients or with comorbidities, may be a treatment option. DLBCL constitutes a group of diseases that activate different biological pathways. Matching specific treatments to a defined genetic alteration is under development. Rituximab biosimilars have become available to a broader population, particularly in developing countries, where access to treatment is limited because of economic resources. Conclusion DLBCL landscape is heterogeneous. R-CHOP immunochemotherapy has been a standard of care for two decades and cures approximately 70% of cases. Molecular characterization of patients is evolving and may have critical therapeutic implications.
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Affiliation(s)
- Myrna Candelaria
- Clinical Research, Instituto Nacional de Cancerología México, Av San Fernando 22, Col Sección XVI, Tlalpan, 14370, Mexico City, Mexico
| | - Alfonso Dueñas-Gonzalez
- Instituto de Investigaciones Biomédicas, UNAM/Instituto Nacional de Cancerología México, Unit of Biomedical Research on Cancer, Mexico City, Mexico
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Navarrete-Reyes AP, Animas-Mijangos K, Gómez-Camacho J, Juárez-Carrillo Y, Torres-Pérez AC, Cataneo-Piña DJ, Negrete-Najar JP, Soto-Perez-de-Celis E. Geriatric principles for patients with cancer. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.5327/z2447-212320212100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cancer is primarily a disease of older persons. Given the heterogeneity of aging, physiological age, rather than chronological age, better expresses the cumulative effect of environmental, medical, and psychosocial stressors, which modifies life expectancy. Comprehensive geriatric assessment, a tool that helps ascertain the physiological age of older individuals, is the gold standard for assessing older adults with cancer. Several international organizations recommend using the geriatric assessment domains to identify unrecognized health problems that can interfere with treatment and predict adverse health-related outcomes, aiding complex treatment decision making. More recently, it has been shown that geriatric assessment-guided interventions improve quality of life and mitigate treatment toxicity without compromising survival. In this review, we discuss the role of comprehensive geriatric assessment in cancer care for older adults and provide the reader with useful information to assess potential treatment risks and benefits, anticipate complications, and plan interventions to better care for older people with cancer.
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Di M, Huntington SF, Olszewski AJ. Challenges and Opportunities in the Management of Diffuse Large B-Cell Lymphoma in Older Patients. Oncologist 2020; 26:120-132. [PMID: 33230948 DOI: 10.1002/onco.13610] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Most patients with diffuse large B-cell lymphoma (DLBCL) are diagnosed at age 60 years or older. Challenges to effective therapy among older individuals include unfavorable biologic features of DLBCL, geriatric vulnerabilities, suboptimal treatment selection, and toxicities of cytotoxic chemotherapy. Wider application of geriatric assessments may help identify fit older patients who benefit from standard immunochemotherapy without unnecessary dose reductions. Conversely, attenuated regimens may provide a better balance of risk and benefit for selected unfit or frail patients. Supportive care with the use of corticosteroid-based prephase, prophylactic growth factors, and early institution of supportive and palliative care can help maximize treatment tolerance. Several novel or emerging therapies have demonstrated favorable toxicity profiles, thus facilitating effective treatment for elderly patients. In the relapsed or refractory setting, patients who are not candidates for stem cell transplantation can benefit from newly approved options including polatuzumab vedotin-based combinations or tafasitamab plus lenalidomide, which may have higher efficacy and/or lower toxicity than historical chemotherapy regimens. Chimeric antigen receptor T-cell therapy has been successfully applied to older patients outside of clinical trials. In the first-line setting, emerging immunotherapy options (bispecific antibodies) and targeted therapies (anti-CD20 antibodies combined with lenalidomide and/or B-cell receptor inhibitors) may provide chemotherapy-free approaches for DLBCL. Enrolling older patients in clinical trials will be paramount to fully examine potential efficacy and toxicity of these strategies. In this review, we discuss recent advances in fitness stratification and therapy that have expanded curative options for older patients, as well as future opportunities to improve outcomes in this population. IMPLICATIONS FOR PRACTICE: Management of diffuse large B-cell lymphoma in older patients poses challenges due to aggressive disease biology and geriatric vulnerability. Although R-CHOP remains standard first-line treatment, geriatric assessment may help evaluate patients' fitness for immunochemotherapy. Corticosteroid prephase, prophylactic growth factors, and early palliative care can improve tolerance of treatment. Novel salvage options (polatuzumab vedotin-based combinations, tafasitamab plus lenalidomide) or chimeric antigen receptor T-cell therapy should be considered in the relapsed or refractory setting for patients ineligible for stem cell transplantation. Emerging immunotherapies (bispecific antibodies) and targeted therapies provide potential first-line chemotherapy-free approaches, which need to be rigorously assessed in clinical trials that involve geriatric patients.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott F Huntington
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Olszewski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Clark AB, Reijnierse EM, Lim WK, Maier AB. Prevalence of malnutrition comparing the GLIM criteria, ESPEN definition and MST malnutrition risk in geriatric rehabilitation patients: RESORT. Clin Nutr 2020; 39:3504-3511. [DOI: 10.1016/j.clnu.2020.03.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/28/2020] [Accepted: 03/17/2020] [Indexed: 01/10/2023]
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Chou WC, Chang H, Wang PN, Kuo MC, Wu JH, Lin TL, Su YJ, Kao HW, Ou CW, Hung CY, Hsueh SW, Hung YS. Application of comprehensive geriatric assessment in predicting early mortality among elder patients with B-cell lymphoma receiving immunochemotherapy. Eur J Haematol 2020; 105:399-407. [PMID: 32472712 DOI: 10.1111/ejh.13457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Early mortality, defined as death within 120 days after initiated antitumor therapy, is an important issue especially for elder patients with B-cell lymphoma. This study aimed to evaluate the clinical value of comprehensive geriatric assessment (CGA) in early mortality prediction in elderly patients with B-cell lymphoma receiving immunochemotherapy. METHODS Seventy-six consecutive patients with newly diagnosed B-cell lymphoma receiving immunochemotherapy from a medical center in Taiwan were prospectively enrolled. Patients were divided into fit (n = 49) and frail (n = 27) groups per pretreatment CGA for early mortality comparison. RESULTS The early mortality rate in our patient cohort was 16% (n = 12): from 6% in patients with no CGA domain impairment to 43% in patients with ≥4 CGA domain impairment. The early mortality rate was 6% and 33% in fit and frail patients (odds ratio, 7.67; 95% CI, 1.86-31.6; P = .005), respectively. Frailty was the significant predictor for early mortality in univariate and multivariate analysis. CONCLUSION In this study, the number of geriatric domain impairment is positively associated with the early mortality risk in elderly patients with B-cell lymphoma. Therefore, CGA can help clinicians to identify the risk of early mortality in elderly patients and provide alternative treatment.
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Affiliation(s)
- Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung Chang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Nan Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chung Kuo
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Hou Wu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Liang Lin
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Jiun Su
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Wen Kao
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Che-Wei Ou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Bai J, Han H, Feng R, Li J, Wang T, Zhang C, Liu H. Comprehensive Geriatric Assessment (CGA): A Simple Tool for Guiding the Treatment of Older Adults with Diffuse Large B-Cell Lymphoma in China. Oncologist 2020; 25:e1202-e1208. [PMID: 32436258 PMCID: PMC7418339 DOI: 10.1634/theoncologist.2019-0738] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background We aimed to validate a simple Comprehensive Geriatric Assessment (CGA) in older adults with diffuse large B‐cell lymphoma (DLBCL) in China and to evaluate the tolerability and efficacy of CGA‐driven therapy. Materials and Methods In total, 78 patients with DLBCL aged ≥60 years were evaluated using CGA with the following parameters: age ≥ 80 years, activities of daily living (ADL), instrumental ADL, and modified cumulative illness rating score for geriatrics. Patients were grouped as fit, unfit, or frail. Patients classified as fit received standard‐dose rituximab plus CHOP, whereas patients in the latter two groups received reduced‐dose or reduced‐agent therapy. The overall response rate (ORR), overall survival (OS), progression‐free survival (PFS), and toxicities in the three groups were evaluated. Results According to the CGA, 45 (57.5%) patients were classified as fit, 5 (6.4%) as unfit, and 28 (35.9%) as frail. The ORR was 82.1% (64/78) among all the patients, including 55 patients (70.6%) who achieved complete response and 9 patients (11.5%) who achieved partial response. In the fit and unfit + frail groups, it achieved 97.8% and 60.6%, respectively. In total, 26 (33.3%) patients (10/45 [22.2%] fit and 16/33 [48.5%] unfit + frail) showed disease progression or recurrence. The median follow‐up time was 18 months (range, 5–62). The 3‐year OS and PFS rates were 82% and 58%, respectively. There were no treatment‐related deaths. Conclusion A simple CGA in older adults with DLBCL may be an effective tool for guiding therapeutic strategies in China. Implications for Practice Diffuse large B‐cell lymphoma (DLBCL) is the most common malignant lymphoma in older adults. The simple tool, Comprehensive Geriatric Assessment (CGA), is proved to be an effective method to identify older adults with DLBCL who are suitable for standard‐dose R‐CHOP regimen therapy. This is the first prospective trial in China to evaluate the tolerability and efficacy of CGA‐driven therapy for older adults with DLBCL, and the result showed that this simple CGA may be an effective tool for guiding therapeutic strategies. Clinicians should take into account geriatric assessment results when recommending chemotherapy. This article evaluates the tolerability and efficacy of Comprehensive Geriatric Assessment‐driven therapy in China.
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Affiliation(s)
- Jie‐Fei Bai
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Hui‐Xiu Han
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Ru Feng
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Jiang‐Tao Li
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Ting Wang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Chun‐Li Zhang
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
| | - Hui Liu
- Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical SciencePeople's Republic of China
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Capelli D, Saraceni F, Fiorentini A, Chiarucci M, Menotti D, Poloni A, Discepoli G, Leoni P, Olivieri A. Feasibility and Outcome of a Phase II Study of Intensive Induction Chemotherapy in 91 Elderly Patients with AML Evaluated Using a Simplified Multidimensional Geriatric Assessment. Adv Ther 2020; 37:2288-2302. [PMID: 32297279 PMCID: PMC7467471 DOI: 10.1007/s12325-020-01310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/04/2022]
Abstract
Introduction We prospectively tested in a phase II study high-dose aracytin and idarubicin plus amifostine as induction regimen in 149 patients with acute myeloid leukaemia (AML) aged ≥ 60 years, evaluated by a simplified multidimensional geriatric assessment (MGA). Methods Ninety-one fully or partially fit patients (61%) were allocated to intensive chemotherapy and 58 (39%) frail patients to best supportive care (BSC). Intensively treated patients, showing early death and complete response (CR) rate respectively of 5.5% and 73.6%, received 61 consolidations, followed by autologous transplant (ASCT), stem cell transplantation (SCT) or gemtuzumab ozogamicin, depending on mobilization outcome and donor availability. Results The 8-year overall survival (OS) of these patients was 20.4%, with median duration of 11.4 months significantly superior to the 1.5 months of BSC arm (p < 0.001). Hyperleukocytosis and cytogenetics were predictors of survival with a relative risk of 1.8 in patients with poor karyotype without hyperleukocytosis (p = 0.02) and 3 in those with hyperleukocytosis (≥ 50,000/μl) (p = 0.002). Conclusion MGA allowed tailored post-consolidation in 53.8% of patients after high-dose aracytin induction, with long-term survival doubling that reported in the literature after standard-dose cytarabine regimens. Trial Registration The study was registered with the Umin Clinical Trial Registry (www.umin.ac.jp/ctr), number R000014052. Electronic Supplementary Material The online version of this article (10.1007/s12325-020-01310-4) contains supplementary material, which is available to authorized users.
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Harkins RA, Chang A, Patel SP, Lee MJ, Goldstein JS, Merdan S, Flowers CR, Koff JL. Remaining challenges in predicting patient outcomes for diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:959-973. [PMID: 31513757 PMCID: PMC6821591 DOI: 10.1080/17474086.2019.1660159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and is an aggressive malignancy with heterogeneous outcomes. Diverse methods for DLBCL outcomes assessment ranging from clinical to genomic have been developed with variable predictive and prognostic success.Areas covered: The authors provide an overview of the various methods currently used to estimate prognosis in DLBCL patients. Models incorporating cell of origin, genomic features, sociodemographic factors, treatment effectiveness measures, and machine learning are described.Expert opinion: The clinical and genetic heterogeneity of DLBCL presents distinct challenges in predicting response to therapy and overall prognosis. Successful integration of predictive and prognostic tools in clinical trials and in a standard clinical workflow for DLBCL will likely require a combination of methods incorporating clinical, sociodemographic, and molecular factors with the aid of machine learning and high-dimensional data analysis.
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Affiliation(s)
- R. Andrew Harkins
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | - Andres Chang
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
| | | | - Michelle J. Lee
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | | | - Selin Merdan
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
- Georgia Institute of Technology, Atlanta, Georgia 30332-0002, USA
| | | | - Jean L. Koff
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
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Tanimura A, Hirai R, Nakamura M, Takeshita M, Hagiwara S, Miwa A. The Prognostic Impact of Dose-attenuated R-CHOP Therapy for Elderly Patients with Diffuse Large B-cell Lymphoma. Intern Med 2018; 57:3521-3528. [PMID: 30101910 PMCID: PMC6355403 DOI: 10.2169/internalmedicine.0990-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective Although R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone) is a standard therapy for diffuse large B-cell lymphoma (DLBCL), the optimal dose for elderly patients remains unclear. Methods and Patients We retrospectively verified our R-CHOP dose-attenuation system implemented from 2005 for DLBCL patients. Among the 115 DLBCL patients treated during 2001-2010, 33 patients treated during 2001-2005 received R-CHOP doses adjusted according to physicians' decisions (PHY group). Eighty-two patients treated after 2005 received adjusted R-CHOP doses according to a unified dose-attenuation system (UNI group). Patients aged <60, 60-69, 70-79, and ≥80 years received the standard R-CHOP, 100% R-CHO+P (50 mg/m2), 100% R+75% CHO+P (40 mg/m2), and 100% R+50% CHO+P (30 mg/m2), respectively. We compared the responses, survival, and treatment cessation between the PHY and UNI groups. Results The patients' characteristics between both groups were closely comparable. All PHY patients received randomly adjusted R-CHOP doses; 94% of UNI patients received scheduled doses. The complete response rates differed significantly between the UNI (77%) and PHY patients (50%) (p=0.011). The two-year event-free survival rates were 50% and 32% in the UNI and PHY groups, respectively (p=0.0083). The two-year OS rates were 77% and 72% in the UNI and PHY group (p=0.16). Among the patients aged >70 years (n=59) overall survival was shorter in the PHY group (62%) than in the UNI group (72%; p=0.02). The UNI group received higher anti-tumor agent doses than the PHY group. The therapy discontinuation rates were 5% in the UNI group and 24% in the PHY group. Conclusion Carrying out unified dose reduction may improve the efficacy and prognosis among elderly DLBCL patients.
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Affiliation(s)
- Akira Tanimura
- Department of Hematology, Tokyo-Kita Medical Center, Japan
| | - Risen Hirai
- Department of Hematology, Tokyo-Kita Medical Center, Japan
| | - Miki Nakamura
- Division of Hematology, National Center for Global Health and Medicine, Japan
| | | | - Shotaro Hagiwara
- Division of Hematology, National Center for Global Health and Medicine, Japan
- Division of Hematology, Tokyo Women' s Medical University, Japan
| | - Akiyoshi Miwa
- Department of Hematology, Tokyo-Kita Medical Center, Japan
- Division of Hematology, National Center for Global Health and Medicine, Japan
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Adjusted Chemotherapy According to Frailty Status in Elderly Patients With Diffuse Large B-Cell Lymphoma: Experience From a Single Referral Center in Mexico City. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:e98-e106. [PMID: 30545670 DOI: 10.1016/j.clml.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chemotherapy is associated with significant toxicity in elderly patients treated for hematological malignancies. Adequate tools to identify the best tailored treatment are essential. PATIENTS AND METHODS Medical charts of patients treated with adjusted chemotherapy for diffuse large B-cell lymphoma according to frailty status between August 1, 2013 and June 30, 2016 were included. Three groups were identified: fit, unfit, and frail patients. RESULTS Fifty-six patients with a median age of 70.5 years were analyzed. Adverse prognostic characteristics were more frequent than expected in the frail group, contributing to a worse outcome. The complete response (CR) rate for all patients was 61.2% (66.6%, 78.3%, and 40.0% for fit, unfit, and frail patients, respectively; P = .121). The 2-year overall survival (OS) for all patients was 78% (87%, 82%, and 59% for fit, unfit, and frail patients, respectively; P = .159) and the mean 2-year disease-free survival was 96% (87% for frail patients and 100% for unfit and fit patients; P = .287). Grade 3/4 hematologic toxicity was present in 83.3%, 65.2%, and 45% of fit, unfit, and frail patients, respectively. CR after therapy had a positive effect on OS, whereas ≥ 2 extranodal sites and febrile neutropenia had a negative effect. CONCLUSION Frailty status assessment resulted in the identification of a group of unfit patients who had adequate tolerance to adjusted chemotherapy (R-choP; rituximab with cyclophosphamide, doxorubicin, and vincristine adjusted to 80% of the corresponding total doses in R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone]) with good results.
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Ørum M, Gregersen M, Jensen K, Meldgaard P, Damsgaard EMS. Frailty status but not age predicts complications in elderly cancer patients: a follow-up study. Acta Oncol 2018; 57:1458-1466. [PMID: 30280625 DOI: 10.1080/0284186x.2018.1489144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purposes were to investigate the health status of elderly cancer patients by comprehensive geriatric assessment (CGA) and to compare the complications with respect to baseline CGA and to evaluate the need for geriatric interventions in an elderly cancer patients' population. MATERIAL Patients aged ≥70 years with lung cancer (LC), cancer of the head and neck (HNC), colorectal cancer (CRC), or upper gastro-intestinal cancer (UGIC) are referred to the Department of Oncology for cancer treatment. METHODS CGA was performed prior to cancer treatment and addressed the following domains: Activities of daily living (ADL), instrumental ADL (IADL), comorbidity, polypharmacy, nutrition, cognition, and depression. Complications, defined as dose reduction and discontinuation of treatment due to grade 3-4 toxicity, hospital admission, shift to palliative treatment, or death within 90 days, were identified from the medical files. Patients were classified as fit, vulnerable, or frail by CGA. PRINCIPAL RESULTS Patients (N = 217) with a median age of 75 years (range: 70-93 yeas) were included: 13% were fit, 35% vulnerable, and 52% frail. CGA significantly predicted admittance to hospital in frail and vulnerable patients compared to fit patients: risk ratio (RR) 2.12 (95% CI: 1.01; 4.46). Vulnerable and frail patients had higher absolute risk of death within 90 days compared to fit patients: 7% and 23% versus 0%. HR for death within 90 days in frail patients as compared to vulnerable patients was 3.50 (95% CI: 1.34; 9.15). More frail patients (88%) needed geriatric interventions than the vulnerable (46%) and fit patients (32%). Major conclusion: Few elderly cancer patients seem to be fit. CGA predicts admittance to hospital in a population of elderly patients with mixed cancer diseases. Frail and vulnerable patients have higher risk of death within 90 days as compared to fit patients.
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Affiliation(s)
- Marianne Ørum
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Kenis C, Baitar A, Decoster L, De Grève J, Lobelle JP, Flamaing J, Milisen K, Wildiers H. The added value of geriatric screening and assessment for predicting overall survival in older patients with cancer. Cancer 2018; 124:3753-3763. [DOI: 10.1002/cncr.31581] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/22/2018] [Accepted: 03/14/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Cindy Kenis
- Department of General Medical Oncology; University Hospitals Leuven; Leuven Belgium
- Department of Geriatric Medicine; University Hospitals Leuven; Leuven Belgium
| | | | - Lore Decoster
- Department of Medical Oncology, Oncology Center, University Hospital Brussels; Vrije Universiteit Brussel; Brussels Belgium
| | - Jacques De Grève
- Department of Medical Oncology, Oncology Center, University Hospital Brussels; Vrije Universiteit Brussel; Brussels Belgium
| | | | - Johan Flamaing
- Department of Geriatric Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Chronic Diseases, Metabolism, and Aging; Catholic University of Leuven; Leuven Belgium
| | - Koen Milisen
- Department of Geriatric Medicine; University Hospitals Leuven; Leuven Belgium
- Department of Public Health and Primary Care, Health Services and Nursing Research; Catholic University of Leuven; Leuven Belgium
| | - Hans Wildiers
- Department of General Medical Oncology; University Hospitals Leuven; Leuven Belgium
- Department of Oncology; Catholic University of Leuven; Leuven Belgium
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Voutsadakis IA. Clinical tools for chemotherapy toxicity prediction and survival in geriatric cancer patients. J Chemother 2018; 30:266-279. [DOI: 10.1080/1120009x.2018.1475442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ioannis A. Voutsadakis
- Division of Medical Oncology, Sault Area Hospital, Sault Ste Marie, Ontario, Canada
- Department of Internal Medicine, Sault Area Hospital, Sault Ste Marie, Ontario, Canada
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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Zhang WH, Li GY, Ma YJ, Li ZC, Zhu Y, Chang J, Hao SG, Tao R. Reduced-dose EPOCH-R chemotherapy for elderly patients with advanced stage diffuse large B cell lymphoma. Ann Hematol 2018; 97:1809-1816. [DOI: 10.1007/s00277-018-3369-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
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Role of anthracycline and comprehensive geriatric assessment for elderly patients with diffuse large B-cell lymphoma. Blood 2017; 130:2180-2185. [PMID: 28814386 DOI: 10.1182/blood-2017-05-736975] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
Abstract
Survival outcome for elderly patients with newly diagnosed diffuse large B-cell lymphoma remains suboptimal in the rituximab era. In this systematic review, we summarize available evidence relevant to the inclusion of anthracycline in upfront chemoimmunotherapy for these elderly patients and highlight the need of prospective clinical trials. With limited prospective data, we find that pretreatment comprehensive geriatric assessment accurately predicts survival and treatment-related toxicities, suggesting its potential role in guiding overall treatment decision-making.
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Gobba S, Moccia AA, Gulden-Sala W, Conconi A, Diem S, Cascione L, Iacoboni G, Margiotta-Casaluci G, Aprile von Hohenstaufen K, Stathis A, Hitz F, Pinotti G, Gaidano G, Zucca E. Outcome of patients older than 80 years with diffuse large B-cell lymphoma (DLBCL) treated with “standard” immunochemotherapy: A large retrospective study from 4 institutions. Hematol Oncol 2017. [DOI: 10.1002/hon.2447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Stefania Gobba
- ASST Sette Laghi; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Alden A. Moccia
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
| | | | - Annarita Conconi
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università degli Studi del Piemonte Orientale; Novara Italy
- Unit of Hematology; Ospedale degli Infermi; Biella Italy
| | - Stefan Diem
- Klinik für Onkologie und Hämatologie; Kantonsspital St Gallen; St Gallen Switzerland
| | - Luciano Cascione
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
- Lymphoma and Genomics Research Program; Institute of Oncology Research (IOR); Bellinzona Switzerland
| | - Gloria Iacoboni
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
| | - Gloria Margiotta-Casaluci
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università degli Studi del Piemonte Orientale; Novara Italy
| | | | | | - Felicitas Hitz
- Klinik für Onkologie und Hämatologie; Kantonsspital St Gallen; St Gallen Switzerland
| | - Graziella Pinotti
- ASST Sette Laghi; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Gianluca Gaidano
- SCDU Ematologia, Dipartimento di Medicina Traslazionale; Università degli Studi del Piemonte Orientale; Novara Italy
| | - Emanuele Zucca
- Istituto Oncologico della Svizzera Italiana; Bellinzona Switzerland
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Cancer-specific geriatric assessment and quality of life: important factors in caring for older patients with aggressive B-cell lymphoma. Support Care Cancer 2017; 25:2833-2842. [DOI: 10.1007/s00520-017-3698-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/31/2017] [Indexed: 12/20/2022]
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Olivieri J, Perna GP, Bocci C, Montevecchi C, Olivieri A, Leoni P, Gini G. Modern Management of Anthracycline-Induced Cardiotoxicity in Lymphoma Patients: Low Occurrence of Cardiotoxicity with Comprehensive Assessment and Tailored Substitution by Nonpegylated Liposomal Doxorubicin. Oncologist 2017; 22:422-431. [PMID: 28275118 DOI: 10.1634/theoncologist.2016-0289] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 11/03/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anthracyclines (AC) are still undeniable drugs in lymphoma treatment, despite occasionally causing cardiotoxicity. Liposomal AC may reduce cardiotoxicity while retaining clinical efficacy; also, biomarker monitoring during chemotherapy allows early detection of cardiac damage, enabling strategies to prevent left ventricular ejection fraction (LVEF) deterioration. MATERIALS AND METHODS We conducted a prospective observational trial in a real-life population of lymphoma patients, combining advanced echocardiography and biomarkers (Troponin I [TnI]) for early detection of cardiotoxicity; we applied a prespecified policy to minimize cardiotoxicity, selecting patients with higher baseline risk to replace doxorubicin with nonpegylated liposomal doxorubicin (NPLD) and starting cardioprotective treatment when subclinical cardiotoxicity was detected. RESULTS Ninety-nine patients received ≥1 cycle of chemotherapy (39 with NPLD): 38 (NPLD = 34) were older than 65 years. At baseline, the NPLD subgroup had more cardiovascular risk factors and comorbidities than the doxorubicin subgroup. After treatment, echocardiographic parameters did not worsen in the NPLD subgroup; significant LVEF reduction occurred in two patients treated with doxorubicin. Over treatment course, TnI rises increased linearly in the doxorubicin subgroup but modestly in the NPLD subgroup. At doxorubicin doses >200 mg/m2 the difference was statistically significant, with more TnI rises in the doxorubicin subgroup. NPLD-treated patients did not experience higher rates of grade 3-4 adverse events. Within the diffuse large B-cell lymphomas category, we observed similar rates of complete and overall responses between doxorubicin- and NPLD-treated patients. CONCLUSION A comprehensive strategy to prevent, detect, and treat cardiotoxicity allows an optimal management of the lymphoma with low incidence of cardiac complications. The Oncologist 2017;22:422-431 IMPLICATIONS FOR PRACTICE: Despite the recent advances of targeted therapy in cancer, old cytotoxic drugs such as anthracyclines (AC) still play a fundamental role in the treatment of many lymphoma patients. We tested and validated in a real-life setting a personalized approach to prevent, detect, and treat AC-induced cardiotoxicity; biomarker monitoring was accomplished by Troponin I measurements before and after chemotherapy infusions, allowing detection of early subclinical cardiotoxicity, which was preemptively treated with cardio-protectants (beta blockers and angiotensin-converting-enzyme inhibitors). A telemedicine system allowed interdisciplinary management of the patients with an expert cardiologist. Furthermore, tailored use of liposomal AC following a prespecified policy appeared to prevent the excess cardiotoxicity expected in high-risk patients.
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Affiliation(s)
- Jacopo Olivieri
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
- UOC Medicina Interna ed Ematologia, Ospedale Generale di Zona, Civitanova Marche, Italy
| | - Gian Piero Perna
- Cardiologia Subintensiva, Presidio "G.M. Lancisi", Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Italy
| | - Caterina Bocci
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
| | | | - Attilio Olivieri
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
| | - Pietro Leoni
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
| | - Guido Gini
- Clinica di Ematologia, Università Politecnica delle Marche, Ancona, Italy
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Comparison of Three Chemotherapy Regimens in Elderly Patients with Diffuse Large B Cell Lymphoma: Experience at a Single National Reference Center in Mexico. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9817606. [PMID: 27478844 PMCID: PMC4958419 DOI: 10.1155/2016/9817606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/16/2016] [Accepted: 06/09/2016] [Indexed: 11/17/2022]
Abstract
Background. Although chemotherapy added to rituximab is a standard of care for diffuse large B cell lymphoma (DLBCL), treatment of patients ≥65 years of age remains controversial due to comorbidities. Methods. This is a retrospective, comparative, nonrandomized study of patients ≥65 years of age, who were diagnosed with DLBCL but not previously treated. Demographic characteristics and comorbidities were analyzed. Three rituximab-containing treatment regimens (standard RCHOP, anthracycline dose-reduced RChOP, and RCOP) were compared. Descriptive analyses were conducted. Survival was calculated with the Kaplan-Meier method, and differences were compared with the log-rank test. Results. In total, 141 patients with a median age of 73.9 years were studied. The three treatment groups had comparable demographic characteristics. The overall response was 77%, 72.5%, and 59% in groups treated with RCHOP, RChOP, and RCOP, respectively. After multivariate analysis, the factors influencing the overall survival were the presence of B symptoms, poor performance status (ECOG ≥ 3), and febrile neutropenia. Factors influencing disease-free survival were febrile neutropenia, high-intermediate and high-risk IPI scores, and treatment without anthracycline. Conclusion. A higher ORR (overall response rate) was achieved with standard RCHOP, which influenced DFS and OS, although it was not statistically significant compared with the other groups. Interventional phase 3 trials testing new molecules in patients aged 70 to 80 years and older are required to improve the prognosis within this growing population.
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Chaganti S, Illidge T, Barrington S, Mckay P, Linton K, Cwynarski K, McMillan A, Davies A, Stern S, Peggs K. Guidelines for the management of diffuse large B-cell lymphoma. Br J Haematol 2016; 174:43-56. [PMID: 27196701 DOI: 10.1111/bjh.14136] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
MESH Headings
- Humans
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Disease Management
- Doxorubicin/therapeutic use
- Frailty/therapy
- HIV Infections/complications
- HIV Infections/therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm, Residual/diagnosis
- Neoplasm, Residual/therapy
- Prednisone/therapeutic use
- Rituximab
- Salvage Therapy/methods
- United Kingdom
- Vincristine/therapeutic use
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Affiliation(s)
- Sridhar Chaganti
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Tim Illidge
- Department of Clinical Oncology, Christie Hospital, Manchester, UK
| | - Sally Barrington
- PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Pam Mckay
- Department of Haematology, West of Scotland Cancer Centre, Glasgow, UK
| | - Kim Linton
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - Kate Cwynarski
- Department of Haematology, Royal Free Hospital, London, UK
| | | | - Andy Davies
- Department of Medical Oncology, Southampton General Hospital, Southampton, UK
| | - Simon Stern
- Department of Haematology, St Helier Hospital, Carshalton, UK
| | - Karl Peggs
- Department of Haematology, University College Hospital, London, UK
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Comprehensive geriatric assessment in elderly patients with newly diagnosed aggressive non-Hodgkin lymphoma treated with multi-agent chemotherapy. J Geriatr Oncol 2015; 6:470-8. [DOI: 10.1016/j.jgo.2015.10.183] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/23/2015] [Accepted: 10/14/2015] [Indexed: 12/22/2022]
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Yoshida M, Nakao T, Horiuchi M, Ueda H, Hagihara K, Kanashima H, Inoue T, Sakamoto E, Hirai M, Koh H, Nakane T, Hino M, Yamane T. Analysis of elderly patients with diffuse large B-cell lymphoma: aggressive therapy is a reasonable approach for 'unfit' patients classified by comprehensive geriatric assessment. Eur J Haematol 2015; 96:409-16. [PMID: 26084899 DOI: 10.1111/ejh.12608] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment strategy for diffuse large B-cell lymphoma (DLBCL) in elderly patients is problematic. Although several researchers have reported the effectiveness of comprehensive geriatric assessment (CGA) and the futility of curative treatment in 'unfit' patients with DLBCL, these propositions are not firmly established. PATIENTS AND METHODS We conducted a retrospective analysis using a database. Patients with DLBCL were eligible if ≧ 60 yr old. CGA stratification was performed using medical records. RESULTS One hundred and 35 patients were identified. Anthracycline-based chemotherapy with curative intent was performed in 115 (85%) patients. According to CGA, 82 (61%) patients were classified as 'fit'. Their 1-yr overall survival (OS) was significantly better than that of 'unfit' patients [91.3% vs. 53.8%, P < 0.001]. Patients classified as 'unfit' treated with curative intent had a significantly better 1-yr OS when compared with those receiving palliative measures [66.1% vs. 19.0%, P < 0.001]. CONCLUSIONS CGA is an effective tool for predicting outcomes in older patients with DLBCL. The patients treated with curative intent had significantly better outcomes compared with those receiving palliation, irrespective of CGA stratification. Curative treatment should be considered even for 'unfit' patients.
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Affiliation(s)
- Masahiro Yoshida
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Takafumi Nakao
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Mirei Horiuchi
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Hideya Ueda
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Kiyoyuki Hagihara
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Hiroshi Kanashima
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Erina Sakamoto
- Department of Haematology, Shitennoji Hospital, Osaka, Japan
| | - Manabu Hirai
- Department of Haematology, Shitennoji Hospital, Osaka, Japan
| | - Hideo Koh
- Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takahiko Nakane
- Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masayuki Hino
- Department of Haematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takahisa Yamane
- Department of Haematology, Osaka City General Hospital, Osaka, Japan
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Aaldriks AA, Giltay EJ, Nortier JWR, van der Geest LGM, Tanis BC, Ypma P, le Cessie S, Maartense E. Prognostic significance of geriatric assessment in combination with laboratory parameters in elderly patients with aggressive non-Hodgkin lymphoma. Leuk Lymphoma 2015; 56:927-35. [DOI: 10.3109/10428194.2014.935364] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Issa DE, van de Schans SAM, Chamuleau MED, Karim-Kos HE, Wondergem M, Huijgens PC, Coebergh JWW, Zweegman S, Visser O. Trends in incidence, treatment and survival of aggressive B-cell lymphoma in the Netherlands 1989-2010. Haematologica 2014; 100:525-33. [PMID: 25512643 DOI: 10.3324/haematol.2014.107300] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Only a small number of patients with aggressive B-cell lymphoma take part in clinical trials, and elderly patients in particular are under-represented. Therefore, we studied data of the population-based nationwide Netherlands Cancer Registry to determine trends in incidence, treatment and survival in an unselected patient population. We included all patients aged 15 years and older with newly diagnosed diffuse large B-cell lymphoma or Burkitt lymphoma in the period 1989-2010 and mantle cell lymphoma in the period 2001-2010, with follow up until February 2013. We examined incidence, first-line treatment and survival. We calculated annual percentage of change in incidence and carried out relative survival analyses. Incidence remained stable for diffuse large B-cell lymphoma (n=23,527), while for mantle cell lymphoma (n=1,634) and Burkitt lymphoma (n=724) incidence increased for men and remained stable for women. No increase in survival for patients with aggressive B-cell lymphoma was observed during the period 1989-1993 and the period 1994-1998 [5-year relative survival 42% (95%CI: 39%-45%) and 41% (38%-44%), respectively], but increased to 46% (43%-48%) in the period 1999-2004 and to 58% (56%-61%) in the period 2005-2010. The increase in survival was most prominent in patients under 65 years of age, while there was a smaller increase in patients over 75 years of age. However, when untreated patients were excluded, patients over 75 years of age had a similar increase in survival to younger patients. In the Netherlands, survival for patients with aggressive B-cell lymphoma increased over time, particularly in younger patients, but also in elderly patients when treatment had been initiated. The improvement in survival coincided with the introduction of rituximab therapy and stem cell transplantation into clinical practice.
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Affiliation(s)
- Djamila E Issa
- Department of Haematology, VU University Medical Centre, Amsterdam
| | | | | | - Henrike E Karim-Kos
- Department of Public Health, Erasmus University Medical Centre Rotterdam, The Netherlands
| | | | - Peter C Huijgens
- Department of Haematology, VU University Medical Centre, Amsterdam Comprehensive Cancer Centre the Netherlands, Utrecht
| | - Jan Willem W Coebergh
- Department of Public Health, Erasmus University Medical Centre Rotterdam, The Netherlands
| | - Sonja Zweegman
- Department of Haematology, VU University Medical Centre, Amsterdam
| | - Otto Visser
- Comprehensive Cancer Centre the Netherlands, Utrecht
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Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen MLG, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014. [PMID: 25071125 DOI: 10.200/jco.2013.54.8347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. METHODS SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. RESULTS GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. CONCLUSION There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
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Tucci A, Martelli M, Rigacci L, Riccomagno P, Cabras MG, Salvi F, Stelitano C, Fabbri A, Storti S, Fogazzi S, Mancuso S, Brugiatelli M, Fama A, Paesano P, Puccini B, Bottelli C, Dalceggio D, Bertagna F, Rossi G, Spina M. Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: a prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL). Leuk Lymphoma 2014; 56:921-6. [DOI: 10.3109/10428194.2014.953142] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 2014; 32:2595-603. [PMID: 25071125 PMCID: PMC4876338 DOI: 10.1200/jco.2013.54.8347] [Citation(s) in RCA: 1166] [Impact Index Per Article: 116.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To update the International Society of Geriatric Oncology (SIOG) 2005 recommendations on geriatric assessment (GA) in older patients with cancer. METHODS SIOG composed a panel with expertise in geriatric oncology to develop consensus statements after literature review of key evidence on the following topics: rationale for performing GA; findings from a GA performed in geriatric oncology patients; ability of GA to predict oncology treatment–related complications; association between GA findings and overall survival (OS); impact of GA findings on oncology treatment decisions; composition of a GA, including domains and tools; and methods for implementing GA in clinical care. RESULTS GA can be valuable in oncology practice for following reasons: detection of impairment not identified in routine history or physical examination, ability to predict severe treatment-related toxicity, ability to predict OS in a variety of tumors and treatment settings, and ability to influence treatment choice and intensity. The panel recommended that the following domains be evaluated in a GA: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes. Although several combinations of tools and various models are available for implementation of GA in oncology practice, the expert panel could not endorse one over another. CONCLUSION There is mounting data regarding the utility of GA in oncology practice; however, additional research is needed to continue to strengthen the evidence base.
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Affiliation(s)
- Hans Wildiers
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Pieter Heeren
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Martine Puts
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Eva Topinkova
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Maryska L.G. Janssen-Heijnen
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Martine Extermann
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Claire Falandry
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Andrew Artz
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Etienne Brain
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Giuseppe Colloca
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Johan Flamaing
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Theodora Karnakis
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Cindy Kenis
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Riccardo A. Audisio
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Supriya Mohile
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Lazzaro Repetto
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Barbara Van Leeuwen
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Koen Milisen
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
| | - Arti Hurria
- Hans Wildiers, Pieter Heeren, Johan Flamaing, Cindy Kenis, and Koen Milisen, University Hospitals Leuven, KU Leuven, Leuven, Leuven, Belgium; Martine Puts, University of Toronto, Toronto, Ontario, Canada; Eva Topinkova, Charles University, Prague, Czech Republic; Maryska L.G. Janssen-Heijnen, VieCuri Medical Centre, Venlo, and Maastricht University Medical Center, Maastricht; Barbara Van Leeuwen, Groningen University, Groningen, the Netherlands; Martine Extermann, University of South Florida, Tampa, FL; Claire Falandry, Lyon University, Pierre-Bénite; Etienne Brain, Hôpital René Huguenin–Institut Curie, Saint-Cloud, France; Andrew Artz, University of Chicago, Chicago, IL; Giuseppe Colloca, Catholic University of Sacred Heart, Rome; Lazzaro Repetto, G. Borea Hospital, Sanremo, Italy; Theodora Karnakis, University of Sao Paulo Medical School, Sao Paulo, Brazil; Riccardo A. Audisio, University of Liverpool, Liverpool, United Kingdom; Supriya Mohile, University of Rochester, Rochester, NY; and Arti Hurria, City of Hope, Duarte, CA
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Puts MTE, Santos B, Hardt J, Monette J, Girre V, Atenafu EG, Springall E, Alibhai SMH. An update on a systematic review of the use of geriatric assessment for older adults in oncology. Ann Oncol 2013; 25:307-15. [PMID: 24256847 DOI: 10.1093/annonc/mdt386] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Our previous systematic review of geriatric assessment (GA) in oncology included a literature search up to November 2010. However, the quickly evolving field warranted an update. Aims of this review: (i) provide an overview of all GA instruments developed and/or in use in the oncology setting; (ii) evaluate effectiveness of GA in predicting/modifying outcomes (e.g. treatment decision impact, treatment toxicity, mortality, use of care). MATERIALS AND METHODS Systematic review of literature published between November 2010 and 10 August 2012. English, Dutch, French and German-language articles reporting cross-sectional or longitudinal, intervention or observational studies of GA instruments were included. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane Library. Two researchers independently reviewed abstracts, abstracted data and assessed the quality using standardized forms. A meta-analysis method of combining proportions was used for the outcome impact of GA on treatment modification with studies included in this update combined with those included in our previous systematic review on the use of GA. RESULTS Thirty-five manuscripts reporting 34 studies were identified. Quality of most studies was moderate to good. Eighteen studies were prospective, 11 cross-sectional and 5 retrospective. Three studies examined treatment decision-making impact and found decisions changed for fewer than half of assessed patients (weighted percent modification is 23.2% with 95% confidence interval (20.3% to 26.1%). Seven studies reported conflicting findings regarding predictive ability of GA for treatment toxicity/complications. Eleven studies examined GA predictions of mortality, and reported that instrumental activities of daily living, poor performance status and more numerous GA deficits were associated with increased mortality risk. Other outcomes could not be meta-analyzed. CONCLUSION Consistent with our previous review, several domains of GA are associated with adverse outcomes. However, further research examining effectiveness of GA on treatment decisions and oncologic outcomes is needed.
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Affiliation(s)
- M T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto
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Sarkozy C, Coiffier B. Diffuse Large B-cell Lymphoma in the Elderly: A Review of Potential Difficulties. Clin Cancer Res 2013; 19:1660-9. [DOI: 10.1158/1078-0432.ccr-12-2837] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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