全面老年评估（CGA）：指导中国老年弥漫大 B 细胞淋巴瘤患者治疗的简单工具。
Comprehensive Geriatric Assessment (CGA): A Simple Tool for Guiding the Treatment of Older Adults with Diffuse Large B-Cell Lymphoma in China.
机构信息
Department of Hematology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, People's Republic of China.
出版信息
Oncologist. 2020 Aug;25(8):e1202-e1208. doi: 10.1634/theoncologist.2019-0738. Epub 2020 Jun 11.
BACKGROUND
We aimed to validate a simple Comprehensive Geriatric Assessment (CGA) in older adults with diffuse large B-cell lymphoma (DLBCL) in China and to evaluate the tolerability and efficacy of CGA-driven therapy.
MATERIALS AND METHODS
In total, 78 patients with DLBCL aged ≥60 years were evaluated using CGA with the following parameters: age ≥ 80 years, activities of daily living (ADL), instrumental ADL, and modified cumulative illness rating score for geriatrics. Patients were grouped as fit, unfit, or frail. Patients classified as fit received standard-dose rituximab plus CHOP, whereas patients in the latter two groups received reduced-dose or reduced-agent therapy. The overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and toxicities in the three groups were evaluated.
RESULTS
According to the CGA, 45 (57.5%) patients were classified as fit, 5 (6.4%) as unfit, and 28 (35.9%) as frail. The ORR was 82.1% (64/78) among all the patients, including 55 patients (70.6%) who achieved complete response and 9 patients (11.5%) who achieved partial response. In the fit and unfit + frail groups, it achieved 97.8% and 60.6%, respectively. In total, 26 (33.3%) patients (10/45 [22.2%] fit and 16/33 [48.5%] unfit + frail) showed disease progression or recurrence. The median follow-up time was 18 months (range, 5-62). The 3-year OS and PFS rates were 82% and 58%, respectively. There were no treatment-related deaths.
CONCLUSION
A simple CGA in older adults with DLBCL may be an effective tool for guiding therapeutic strategies in China.
IMPLICATIONS FOR PRACTICE
Diffuse large B-cell lymphoma (DLBCL) is the most common malignant lymphoma in older adults. The simple tool, Comprehensive Geriatric Assessment (CGA), is proved to be an effective method to identify older adults with DLBCL who are suitable for standard-dose R-CHOP regimen therapy. This is the first prospective trial in China to evaluate the tolerability and efficacy of CGA-driven therapy for older adults with DLBCL, and the result showed that this simple CGA may be an effective tool for guiding therapeutic strategies.
背景
本研究旨在验证一种适用于中国老年弥漫大 B 细胞淋巴瘤（DLBCL）患者的简化综合老年评估（CGA），并评估 CGA 指导下的治疗的耐受性和疗效。
材料和方法
共纳入 78 例年龄≥60 岁的 DLBCL 患者，使用 CGA 评估以下参数：年龄≥80 岁、日常生活活动（ADL）、工具性日常生活活动（IADL）和改良累积疾病评分。患者被分为适合、不适合或虚弱。适合的患者接受标准剂量利妥昔单抗联合 CHOP 治疗，而后两组患者接受低剂量或低药物治疗。评估三组患者的总体缓解率（ORR）、总生存期（OS）、无进展生存期（PFS）和毒性反应。
结果
根据 CGA，45 例（57.5%）患者被归类为适合，5 例（6.4%）为不适合，28 例（35.9%）为虚弱。所有患者的 ORR 为 82.1%（64/78），包括 55 例（70.6%）完全缓解和 9 例（11.5%）部分缓解。在适合和不适合+虚弱组中，ORR 分别为 97.8%和 60.6%。共有 26 例（33.3%）患者（10/45[22.2%]适合和 16/33[48.5%]不适合+虚弱）出现疾病进展或复发。中位随访时间为 18 个月（5-62 个月）。3 年 OS 和 PFS 率分别为 82%和 58%。无治疗相关死亡。
结论
适用于中国老年 DLBCL 患者的简化 CGA 可能是指导治疗策略的有效工具。
意义
弥漫大 B 细胞淋巴瘤（DLBCL）是老年人最常见的恶性淋巴瘤。简单的综合老年评估（CGA）工具已被证明是一种有效的方法，可识别适合接受标准剂量 R-CHOP 方案治疗的老年 DLBCL 患者。这是中国首次前瞻性评估 CGA 指导治疗对老年 DLBCL 患者的耐受性和疗效的试验，结果表明这种简单的 CGA 可能是指导治疗策略的有效工具。
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