Rosko Ashley E, Huang Ying, Wall Sarah A, Mims Alice, Woyach Jennifer, Presley Carolyn, Williams Nicole O, Stevens Erin, Han Claire J, Von Ah Diane, Islam Nowshin, Krok-Schoen Jessica L, Burd Christin E, Naughton Michelle J
Division of Hematology, The Ohio State University, Columbus, OH, United States of America.
Division of Hematology, The Ohio State University, Columbus, OH, United States of America.
J Geriatr Oncol. 2025 Jan;16(1):102144. doi: 10.1016/j.jgo.2024.102144. Epub 2024 Nov 5.
Chemotherapy toxicity tools are rarely studied in patients with hematologic malignancy (HM). The primary aim of this pilot study was to determine the predictive ability of the Cancer and Aging Research Group (CARG) chemo-toxicity calculator in estimating grade 3-5 toxicity in patients with HM.
Patients 60 years and older with HM were prospectively evaluated using the CARG chemo-toxicity calculator. Discrimination and calibration were checked by applying the published model in our data. Additionally, a full geriatric assessment (GA), the Short Physical Performance Battery (SPPB), and health related quality of life (HRQoL) were captured longitudinally at the start of treatment and at end of study. Secondary aims explored the association of GA metrics with chemo-related toxicities and survival.
One hundred forty-five patients were approached, 118 patients consented, and 97 patients were evaluable. Most patients were newly diagnosed (n = 91). The median CARG score was 9 (range 4-18). The CARG score was not validated in our cohort of older patients with HM, with area under the receiver operation characteristic curve being 0.53 (95 % CI: 0.41-0.65). In multivariable analysis, after controlling for disease type, risk factors associated with grade 3-5 toxicity included living alone (hazard ratio [HR] 4.24, 95 %CI: 2.07-8.68, p < 0.001), increase in body mass index (HR 1.06, 95 %CI: 1.01-1.12, p = 0.03) and a higher social activities score (HR 1.27, 95 %CI: 1.06-1.51, p = 0.01). In multivariable analysis of overall survival, the only prognostic factor was an objective marker of physical function (SPPB score HR = 0.85, 95 %CI:0.78-0.93, p < 0.001).
The CARG chemo-toxicity calculator was not predictive of grade 3-5 toxicity in patients with hematologic malignancy. The SPPB was associated with overall survival in multivariable analysis, suggesting future use as an objective biomarker in HM. We also report a comprehensive trajectory of function, QoL, psychosocial well-being, and cognition among older adults with HM. The predictive accuracy of the CARG chemo-toxicity calculator may be affected by the diverse range of HM treatment options that are not traditional chemotherapy.
化疗毒性工具在血液系统恶性肿瘤（HM）患者中很少得到研究。这项初步研究的主要目的是确定癌症与衰老研究组（CARG）化疗毒性计算器在估计HM患者3 - 5级毒性方面的预测能力。
对60岁及以上的HM患者使用CARG化疗毒性计算器进行前瞻性评估。通过将已发表的模型应用于我们的数据来检查区分度和校准情况。此外，在治疗开始时和研究结束时纵向收集全面的老年评估（GA）、简短体能表现量表（SPPB）以及健康相关生活质量（HRQoL）。次要目的是探讨GA指标与化疗相关毒性及生存的关联。
共纳入145例患者，118例患者同意参与，97例患者可进行评估。大多数患者为新诊断病例（n = 9）。CARG评分的中位数为9（范围4 - 18）。CARG评分在我们的老年HM患者队列中未得到验证，受试者操作特征曲线下面积为0.53（95%CI：0.41 - 0.65）。在多变量分析中，在控制疾病类型后，与3 - 5级毒性相关的危险因素包括独居（风险比[HR] 4.24，95%CI：2.07 - 8.68，p < 0.001）、体重指数增加（HR 1.06，95%CI：1.01 - 1.12，p = 0.03）以及较高的社会活动评分（HR 1.27，95%CI：1.06 - 1.51，p = 0.01）。在总生存的多变量分析中，唯一的预后因素是身体功能的客观指标（SPPB评分HR = 0.85，95%CI：0.78 - 0.93，p < 0.001）。
CARG化疗毒性计算器不能预测血液系统恶性肿瘤患者的3 - 5级毒性。在多变量分析中，SPPB与总生存相关，提示其未来可作为HM中的客观生物标志物。我们还报告了老年HM患者在功能、生活质量、心理社会幸福感和认知方面的全面变化轨迹。CARG化疗毒性计算器的预测准确性可能受到非传统化疗的多种HM治疗方案的影响。
