Impact of frailty in survival of older patients with classical Hodgkin lymphoma: A retrospective, multicenter study from the spanish registry of lymphoma (RELINF) of the spanish group of lymphoma (GELTAMO)
Abstract
Abstract Introduction. The outcomes of older adults with classical Hodgkin Lymphoma (cHL) have improved in recent decades. However, despite having better treatment strategies and better supportive care, the prognosis remains poor for those aged ≥70 years. Frailty has been associated with poor outcomes and worse tolerance of treatments in older patients with hematological malignancies. Hence, there are recommendations to perform geriatric assessment (GA) and to integrate it into the treatment decision plan, but the implementation in clinical practice is still limited. Methods. We conducted a retrospective, multicenter study in the Spanish Lymphoma Registry (RELINF) of the Spanish Lymphoma Group (GELTAMO). Hereby, we enrolled in this study 673 patients with cHL aged 60 years or above from 46 Spanish centers. We analyzed the impact of comorbidities and frailty on their outcome. We collected baseline patient characteristics, including activities of daily living (ADL), instrumental activities of daily living (IADL), geriatric syndromes, and comorbidities scored with CIRS-G. Statistical analyses were done with R. Results. Median age at diagnosis was 72 years (range 60-93), 57.8% were male, 65.7% were diagnosed with advanced stage, and 43.9% with extranodal involvement. CIRS score was collected in 417 patients, with a median score of 4 (range 0-13). Activities of daily living (ADL) were collected in 569 patients, with 79 (13.9%) of them showing impairments. Instrumental activities of daily living (IADL) were collected in 532 patients, with impairments in 94 (17.7%) of them. Geriatric syndromes were detected in 84 patients (14.4%). In the univariate analyses, age >71 years (HR 1.08, 95%CI 1.06-1.10, p<0.001), previous history of cardiovascular disease (HR 1.79, 95%CI 1.35-2.39, p<0.001), extranodal involvement (HR 1.69, 95%CI 1.28-2.23, p<0.001), advanced stage (HR 4.99, 95%CI 2.18-11.4, p<0.001), ECOG >2 (HR 10.4, 95%CI 6.64-16.2, p<0.001), impairment in ADL (HR 3.78, 95%CI 2.66-5.36, p<0.001), and IADL (HR 3.75, 95%CI 2.65-5.30, p<0.001), presence of geriatric syndromes (HR 1.83, 95%CI 1.25-2.68, p=0.002), and cardiac (HR 1.85, 95%CI 1.28-22.65, p=0.001), and psychiatric (HR 1.80, 95%CI 1.21-2.67, p=0.004) comorbidities had a negative impact in the survival. In lab tests, only absolute lymphocyte counts (ALC), hemoglobin, albumin and ESR had impact in survival. With regard to treatments, no differences were seen among all therapies. Only palliative regimens showed shorter survival (HR 11.5, 95%CI 7.73-17.2, p<0.001). In the multivariate analysis, age, ECOG, anemia, geriatric syndromes and palliative therapy had an impact on OS. Conclusions. Functional reserve and resilience have an impact on the outcome of older patients with cHL. Frailty assessment through a GA should be incorporated in the evaluation of older patients with cHL to identify those patients at higher risk. Better and safer treatment strategies are needed to overcome the poorer prognosis of this group of patients.
Article Details
Authors (52)
Raúl Córdoba
Maria Carmen Martinez Munoz
1Hospital Clinic of Barcelona, Barcelona, Spain
Rosa Maria Rodriguez Nunez
3Complejo Hospitalario Universitario Vigo, Vigo, Spain
Blanca Sánchez-González
23Hospital del Mar (Hospital Universitario), Hematology, Barcelona, Spain
Miriam Moreno
17ICO Hospital Germans Trias i Pujol, Hematology, Barcelona, Spain
Norma Gutierrez
David Alonso Castronuño
6Hospital de Salamanca, Salamanca, Spain
Jimena Cannata
29Hospital Universitario de La Princesa, Hematology, Madrid, Spain
Pilar Gomez Prieto
10Hospital Universitario La Paz, Madrid, Spain
Laurentino Benito
9Hospital de Getafe, Getafe, Spain
Tamara Torrado
10Complejo Hospitalario Universitario A Coruna, A Coruna, Spain
Joan Buch
11Hospital Josep Trueta, Girona, Spain
Juan Carlos Caballero
12Fundacion Jimenez Diaz, Madrid, Spain
Nazaret Dominguez
19Hospital Universitario Virgen Macarena, Hematology, Sevilla, Spain
Raquel Santiago Alonso
5Hospital Sant Joan de Déu, Manresa, Spain
Isabel González-gascón-y-Marín
5Hospital Infanta Leonor, Madrid, Spain
Maria Moya Arnao
16Hospital Morales Meseguer, Murcia, Spain
Beatriz De La Cruz
10Hospital Universitario La Paz, Madrid, Spain
Cecilia Carpio
6University Hospital Vall d'Hebron, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
Maria Dolores Gutiérrez-Meca Maestre
18Hospital Santa Lucia, Cartagena, Spain
Luis Antonio López Gómez
42Hospital Royo Villanova, Zaragoza, Spain
Eukene Gainza
20Hospital Galdakao, Galdakao, Spain
Maria Rocio Figueroa Mora
1Clínica Universidad de Navarra, Hematology Department, Pamplona, Spain
Paula Fernández-Caldas
1Hospital General Universitario Gregorio Marañón, Department of Hematology and Hemotherapy, Madrid, Spain
Mariana Bastos-Oreiro
9Department of Hematology, Gregorio Marañón Research Institute, Madrid, Spain
Paola Villafuerte Gutiérrez
33Hospital Universitario Príncipe de Asturias, Hematology, Madrid, Spain
Samuel Romero Dominguez
2Hospital Universitario La Fe, Valencia, Spain
Belen Navarro Matilla
25Hospital Puerta de Hierro, Majadahonda, Spain
Izaskun Zeberio
26Hospital Donostia, San Sebastian, Spain
Emilia Pardal De La Mano
22Hospital Virgen del Puerto, Plasencia, Spain
Antonio Gutiérrez
Eva Donato
27Hospital Universitario Doctor Peset, Hematology, Valencia, Spain
Javier Nuñez
30Hospital Marques de Valdecilla, Santander, Spain
Teresa Cobo
60Hospital Universitario del Sureste, Madrid, Spain
Begona Mendibil
26Hospital Donostia, San Sebastian, Spain
Inigo Olazabal Eizaguirre
16Hospital Universitario de Donostia, Hematology, San Sebastián, Spain
Maria Isabel Gomez Roncero
16Complejo Hospitalario de Toledo, Toledo, Spain
Cristina Barrenetxea
33Hospital de Basurto, Bilbao, Spain
Haridian de la Nuez
34Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain
Sara Ferrero
35Hospital Lucus Augusti, Lugo, Spain
Roberto Trelles
4Fundación Alcorcón Hospital, Madrid, Spain
Maria Garcia Roa
36Hospital Fundacion Alcorcon, Alcorcon, Spain
Luis Ignacio Sancho Val
37Hospital Lozano Blesa, Zaragoza, Spain
Sofia Martin-Consuegra
31Hospital Comarcal de Alcañiz, Hematology, Teruel, Spain
Maria Luisa Bengochea
23Hospital Universitario Severo Ochoa, Hematology, Madrid, Spain
Carmen Alonso Prieto
40Hospital Arnau Vilanova, Valencia, Spain
Elena Ramila
41Hospital Parc Tauli, Sabadell, Spain
Hugo Daniel Luzardo Henríquez
11Hospital Universitario de Gran Canaria Doctor Negrín, Hematology, Gran Canaria, Spain
Maria Jesus Peñarrubia
43Hospital Clinico Valladolid, Valladolid, Spain
Alfonso Ortiz
44Hospital HM Sanchinarro, Madrid, Spain
Ignacio Mahillo
Eva Domingo Domenech
6Department of Hematology, Hospital Duran i Reynals, Institut Català d’Oncologia, Institut d'Investigació de Ciències Biomèdiques de Bellvitge, Barcelona, Spain