老年预后指数可预测老年弥漫性大B细胞淋巴瘤患者的早期死亡率。意大利淋巴瘤基金会对老年项目的一项专项分析。

The elderly prognostic index predicts early mortality in older patients with diffuse large B-cell lymphoma. An ad hoc analysis of the elderly project by the Fondazione Italiana Linfomi.

作者信息

Cencini Emanuele, Tucci Alessandra, Puccini Benedetta, Cavallo Federica, Luminari Stefano, Usai Sara Veronica, Fabbri Alberto, Pennese Elsa, Marino Dario, Zilioli Vittorio Ruggero, Balzarotti Monica, Petrucci Luigi, Tafuri Agostino, Arcari Annalisa, Botto Barbara, Zanni Manuela, Hohaus Stefan, Sartori Roberto, Merli Michele, Gini Guido, Al Essa Wael, Musurca Gerardo, Tani Monica, Nassi Luca, Daffini Rosa, Mammi Caterina, Marcheselli Luigi, Bocchia Monica, Spina Michele, Merli Francesco

机构信息

Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.

Hematology Division, ASST Spedali Civili Brescia, Brescia, Italy.

出版信息

Hematol Oncol. 2023 Feb;41(1):78-87. doi: 10.1002/hon.3081. Epub 2022 Oct 7.

DOI:10.1002/hon.3081

PMID:36177902

Abstract

The Elderly Prognostic Index (EPI) is based on the integration of a simplified geriatric assessment, hemoglobin levels and International Prognostic Index and has been validated to predict overall survival in older patients with diffuse large B-cell lymphoma (DLBCL). In this study, we evaluated the ability of EPI to predict the risk of early mortality. This study included all patients registered in the Elderly Project for whom treatment details and a minimum follow-up of 3 months were available. Three main treatment groups were identified based on the anthracycline amount administered: cases receiving >70% of the theoretical anthracyclines dose (Full Dose [FD] group), ≤70% (Reduced Dose [RD]) and palliative therapy (PT; no anthracyclines). The primary endpoint was early mortality rate, defined as death for any cause occurring within 90 days from diagnosis. We identified 1150 patients with a median age of 76 years (range 65-94). Overall, 69 early deaths were observed, accounting for 19% of all reported deaths. The cumulative rate of early mortality at 90 days was 6.0%. Comparing early with delayed deaths, we observed a lower frequency of deaths due to lymphoma progression (42% vs. 75%; p < 0.001) and a higher frequency due to toxicity and infections (22% vs. 4%, p < 0.001, and 22% vs. 3%, p < 0.001, respectively) for early events. A multivariable logistic analysis on 931 patients (excluding PT) confirmed an independent association of high-risk EPI (odds ratio [OR] 3.60; 95% confidence interval [CI] 1.15-11.2) and bulky disease (OR 2.08; 95% CI 1.09-3.97) with the risk of early mortality. The cumulative incidence of early mortality for older patients with DLBCL is not negligible and is mainly associated with non-lymphoma related events. For patients receiving anthracyclines, high-risk EPI and bulky disease are associated with a higher probability of early mortality.

摘要

老年预后指数（EPI）基于简化老年评估、血红蛋白水平和国际预后指数的整合，已被证实可预测老年弥漫性大B细胞淋巴瘤（DLBCL）患者的总生存期。在本研究中，我们评估了EPI预测早期死亡风险的能力。本研究纳入了老年项目中所有有治疗细节且至少随访3个月的患者。根据蒽环类药物的给药量确定了三个主要治疗组：接受理论蒽环类药物剂量>70%的患者（全剂量[FD]组）、≤70%的患者（减量[RD]组）和姑息治疗患者（PT组；未使用蒽环类药物）。主要终点是早期死亡率，定义为诊断后90天内任何原因导致的死亡。我们确定了1150例患者，中位年龄为76岁（范围65 - 94岁）。总体而言，观察到69例早期死亡，占所有报告死亡病例的19%。90天时的早期死亡率累积率为6.0%。比较早期死亡和延迟死亡，我们观察到早期事件中因淋巴瘤进展导致的死亡频率较低（42%对75%；p < 0.001），而因毒性和感染导致的死亡频率较高（分别为22%对4%，p < 0.001，以及22%对3%，p < 0.001）。对931例患者（不包括PT组）进行的多变量逻辑分析证实，高危EPI（优势比[OR] 3.60；95%置信区间[CI] 1.15 - 11.2）和大包块病（OR 2.08；95% CI 1.09 - 3.97）与早期死亡风险独立相关。DLBCL老年患者的早期死亡率累积发生率不可忽视，且主要与非淋巴瘤相关事件有关。对于接受蒽环类药物治疗的患者，高危EPI和大包块病与早期死亡的较高可能性相关。