Abstract
Background: Patient-related factors, namely comorbidities, impact the clinical outcome of patients with diffuse large B-cell lymphoma (DLBCL). Methods: The prevalence and prognostic impact of comorbidities were examined using the validated scores Charlson Comorbidity Index (CCI) and Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) in 181 patients with DLBCL at initial diagnosis before treatment with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone (R-CHOP). Results: Pronounced comorbidities as defined by CCI and HCT-CI scoring of ≥2 were detected in 9.9% and 28.2% of patients, respectively, and occurred more frequently at advanced age (p < 0.001). Higher CCI scoring was associated with lower complete response rate (p = 0.020). Both advanced CCI and HCT-CI were significantly associated with shortened overall survival (3-year OS: CCI ≥2 vs. 0–1, 38.9% vs. 81.3%, p < 0.001; HCT-CI ≥2 vs. 0–1, 56.9% vs. 84.9%, p < 0.001). Both comorbidity scores remained independent risk factors in the multivariate analysis (HCT-CI ≥2 HR: 2.6, p = 0.004; CCI ≥2 HR: 3.6, p = 0.001). Conclusion: This study demonstrates the prognostic relevance of comorbidities classified by CCI and HCT-CI in patients with DLBCL undergoing curative treatment with R-CHOP. A structured evaluation of comorbidities might refine prognostication alongside currently used prognostic parameters, namely age, and should be evaluated in prospective trials.
Highlights
Diffuse large B cell lymphoma (DLBCL) accounts for approximately 25–30% of all types of non-Hodgkin lymphomas (NHL), representing the most common histological subtype [1]
As the International Prognostic Index (IPI) classification was developed in the pre-rituximab era, when predominantly patients below the age of 60 were eligible for intensified treatment regimens, the cutoff for age as a risk factor was set at 60 years [5]
Several large trials have shown improved survival in diffuse large B-cell lymphoma (DLBCL) patients >60 years using the combination of rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone (R-CHOP) [6,7,8,9,10]
Summary
Diffuse large B cell lymphoma (DLBCL) accounts for approximately 25–30% of all types of non-Hodgkin lymphomas (NHL), representing the most common histological subtype [1]. Several large trials have shown improved survival in DLBCL patients >60 years using the combination of rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone (R-CHOP) [6,7,8,9,10]. The broad availability of granulocyte colony-stimulating factor (G-CSF) has facilitated comparable dose intensities in both older and younger patients [11] Guidelines recommend this immune-chemotherapy, even in selected subgroups of patients at advanced age [4,12]. Methods: The prevalence and prognostic impact of comorbidities were examined using the validated scores Charlson Comorbidity Index (CCI) and Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) in 181 patients with DLBCL at initial diagnosis before treatment with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone (R-CHOP). A structured evaluation of comorbidities might refine prognostication alongside currently used prognostic parameters, namely age, and should be evaluated in prospective trials
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