Abstract
Nutritional assessments, including the Geriatric Nutritional Risk Index (GNRI), have emerged as prediction tools for long-term survival in various cancers. This study aimed to investigate the therapeutic strategy and explore the prognostic factors in the elderly patients (≥65 years) with diffuse large B cell lymphoma (DLBCL). The cutoff value of the GNRI score (92.5) was obtained using the receiver operating characteristic curve. Among these patients (n = 205), 129 (62.9%) did not receive standard R–CHOP chemotherapy. Old age (≥80 years), poor performance status, low serum albumin level, and comorbidities were the major factors associated with less intensive anti-lymphoma treatment. Further analysis demonstrated that a lower GNRI score (<92.5) was linked to more unfavorable clinical features. In the patients who received non-anthracycline-containing regimens (non-R–CHOP), multivariate analysis showed that a low GNRI can serve as an independent predictive factor for worse progression-free (HR, 2.85; 95% CI, 1.05–7.72; p = 0.039) and overall survival (HR, 2.98; 95% CI, 1.02–8.90; p = 0.045). In summary, nutritional evaluation plays a role in DLBCL treatment and the GNRI score can serve as a feasible predictive tool for clinical outcomes in frail elderly DLBCL patients treated with non-anthracycline-containing regimens.
Highlights
Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), accounting for approximately 35% of newly diagnosed lymphoma cases, with the average age of diagnosis exceeding 65 years [1]
We investigated the prognostic factors within the non-R–CHOP group by stratifying patients into the R-chemotherapy group for those receiving chemotherapeutic regimens other than R–CHOP and the non-chemotherapy group for those given singleagent rituximab, steroid monotherapy, or rituximab plus steroid treatment
Our results suggested that low Geriatric Nutritional Risk Index (GNRI) and age-adjusted IPI (aaIPI), rather than the Charlson Comorbidity Index (CCI), are independent risk factors for progression-free survival (PFS) and overall survival (OS) in the non-R–CHOP group after adjustment for various clinical parameters
Summary
Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), accounting for approximately 35% of newly diagnosed lymphoma cases, with the average age of diagnosis exceeding 65 years [1]. Treatment strategies are often highly individualized in elderly patients, who are more likely to suffer from life-threatening chemotherapy-related toxicity due to chronic or weakness-associated diseases [6]. Nationwide database analyses in many countries showed that more than 50% of the elderly patients did not receive anthracycline-containing regimens as the first-line treatment [7,8,9]. The international prognostic index (IPI) and the age-adjusted IPI (aaIPI) have been widely used as prognostic tools in DLBCL [10]. These models were developed based on patients receiving anthracycline-containing regimens, and more than half of the participants were under 60 years old, limiting their application in elderly patients receiving a less intensive therapy. Nutritional status and comorbidity assessment tools have emerged as critical factors of predicting the long-term prognosis in these subgroups [11,12,13,14,15,16,17]
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