Hematology Unit, Campus Bio-Medico University Hospital, Rome, Italy.
J Geriatr Oncol. 2013 Jul;4(3):242-8. doi: 10.1016/j.jgo.2013.04.003. Epub 2013 May 7.
The clinical outcome of elderly (≥75years) patients with aggressive B-cell non-Hodgkin lymphoma (B-NHL) is not firmly established because few studies have specifically addressed this issue. In addition, the usefulness of a comprehensive geriatric assessment (CGA) in B-NHL still needs to be deeply explored.
We evaluated the prognostic factors of 73 patients aged ≥75years (median age: 78) with B-NHL treated by clinical judgment with curative anthracycline-based approaches (n=36) or with conservative treatments without anthracyclines (n=37). Analysis of clinical outcomes also included baseline CGA stratification.
The curative approaches resulted in a better clinical outcome than conservative approaches [overall response rate: 91.2% vs. 69.7%, P=0.003; 2-year progression-free survival: 47.2% vs. 21.6%, P=0.006; and 2-year overall survival (OS): 58.3% vs 24.3%, P=0.003] with similar safety profiles. Independent of treatment type, patients classified as "fit" and "intermediate" by CGA presented with better OS compared to patients classified as "frail" (P<0.001). Patients classified as "fit" and "intermediate" who were receiving curative treatments presented with a significantly better OS when compared with those treated conservatively on the basis of clinical judgment. A curative anthracycline-based therapy (P=0.048), the response to treatment (P=0.017) and a "frail" condition (P=0.031) were the only factors affecting OS in multivariate analysis.
Present data indicates that even in elderly patients with B-NHL curative anthracycline-based therapies are more effective than conservative approaches. However, choice of treatment should rely more on objective than on subjective parameters. Therefore, further prospective trials are warranted to better define the CGA role in hematopoietic malignancies.
由于很少有研究专门针对这一问题，因此高龄（≥75 岁）侵袭性 B 细胞非霍奇金淋巴瘤（B-NHL）患者的临床结局尚不确定。此外，全面老年评估（CGA）在 B-NHL 中的作用仍需要深入探讨。
我们评估了 73 例年龄≥75 岁（中位年龄：78 岁）B-NHL 患者的预后因素，这些患者接受了临床判断的治愈性蒽环类药物治疗方法（n=36）或不使用蒽环类药物的保守治疗（n=37）。临床结局分析还包括基线 CGA 分层。
与保守治疗相比，治愈性方法可获得更好的临床结局[总缓解率：91.2% vs. 69.7%，P=0.003；2 年无进展生存率：47.2% vs. 21.6%，P=0.006；2 年总生存率（OS）：58.3% vs. 24.3%，P=0.003]，且安全性相似。无论治疗类型如何，根据 CGA 分类为“健康”和“中等”的患者 OS 均优于分类为“脆弱”的患者（P<0.001）。与基于临床判断接受保守治疗的患者相比，接受治愈性治疗且分类为“健康”和“中等”的患者 OS 显著更好。多变量分析中，仅蒽环类药物为基础的治愈性治疗（P=0.048）、治疗反应（P=0.017）和“脆弱”状态（P=0.031）是影响 OS 的唯一因素。
目前的数据表明，即使在老年 B-NHL 患者中，蒽环类药物为基础的治愈性治疗也比保守治疗更有效。然而，治疗选择应更多地依赖客观参数而不是主观参数。因此，需要进一步的前瞻性试验来更好地确定 CGA 在血液恶性肿瘤中的作用。
