Frailty status of patients significantly associated with 1-year mortality in DLBCL

In one study, a correlation between frailty and death at 1 year was identified in patients with diffuse large B-cell lymphoma.

In a large population-based study of patients with diffuse large B-cell lymphoma (DLBCL), researchers confirmed that patient frailty status was significantly correlated with 1-year mortality regardless of several contributing factors, according to the results. published in the Journal of the National Comprehensive Cancer Network.1

Using linked population-based data from the Institute for Clinical Evaluative Sciences (ICES) in Ontario, Canada, researchers conducted a retrospective cohort study of 5,527 patients aged 66 or older diagnosed with a DLBCL between January 1, 2006 and December 31, 2017 Of this cohort, 2,699 patients were identified as frail based on a modified version of the Generalizable Frailty Index (FI) used in administrative health data of Ontario.

The researchers found that during the first 90 days after starting first-line rituximab, the probability of survival ± standard error in frail patients was 86% ± 0.67%, compared to 93% ± 0, 47% in non-frail patients (P

The overall relationship with frailty and survival remained constant when measured in quartiles with an unadjusted RR of 1.6 (95% CI, 1.3-1.9) at T2.2 [95% CI, 1.7–2.4] at Q3, and 2.7 [95% CI, 2.3–3.2] for T4, compared to T1 (P P P

There was no significant difference between the mean age at death for the frail or non-frail group at 80 and 79 years, respectively. However, frail patients were more likely to die during treatment for their cancer with a 20.6% risk of death compared to 17.7% in the non-frail group (P = 0.0472), whereas frail patients were less likely to die from lymphoma at 70.8% compared to 69.6% for non-frail patients (P = 0.506).

A total of 2,351 patients were hospitalized and 192 of these patients died in hospital. Frail patients were significantly more likely to visit the emergency department, be admitted to hospital, or be admitted to intensive care than non-frail patients during the first 2 cycles and throughout treatment. During the first 2 treatment cycles, 666 frail patients had at least 1 emergency room visit compared to 561 non-frail patients (P P

“What remains unclear is whether the underlying cause of mortality in frail patients is undertreatment or poor treatment tolerance,” the researchers wrote in discussion of their findings. “Although we found that frail patients tended to have more dose delays than non-frail patients, a significant number in both groups (41%) had at least 1 dose delay.”

The Frailty Index contains 30 multidimensional variables indicating frailty (eg, supported independent living, socioeconomic status, mobility, health care utilization, comorbidities). According to the researchers, the index is calculated as the sum of all deficits divided by the total number of measured deficits. In this analysis, exposure was categorized into a binary of fragile greater than 0.21 and non-fragile of 0.21 or less.

Healthcare utilization was included in this study to replace serious treatment-related toxicity. In terms of health care utilization from start to end of treatment, frail patients received less chemotherapy (39) than non-frail patients (52), and more patients reported difficulty managing their home symptoms, palliative care and in-hospital symptom management (107 patients vs 72 non-frail patients).

Fourteen percent of frail patients received only one cycle of chemoimmunotherapy versus 7% of non-frail patients (P P P

“This study highlights the importance of baseline frailty assessment in patients with DLBCL. Future work should focus on whether frail patients can be further stratified to identify those with the highest risk of early death and whether knowledge of the impacts of frailty on treatment outcomes affects treatment decisions and quality of life for patients and providers,” the researchers concluded. “In addition, future trials Clinics should consider frailty status in their design and report outcomes stratified by frailty.”

References

Vijenthira A, Mozessohn L, Nagamuthu C, et al. Frailty in patients with newly diagnosed diffuse large B-cell lymphoma receiving treatment with curative intent: a population-based study. J Natl Compr Canc Netw. 2022 Jun;20(6):635-642.e9. doi: 10.6004/jnccn.2022.7014

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